Surveillance of and Risk Fztors for Difficult Intubation At Srinagarind Hosipital

Objective:  To identify the incidence of, and risk factors for, difficult intubation during anesthesia at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.Design:  Descriptive, prospective study.Methods:  Our study was part of a multi-center study conducted in 2003 by the Thai Royal College of Anesthesiologists aimed at surveillance of anesthetic-related complications in Thailand.  We collected the data from all of the cases receiving anesthesia service at Srinagarind Hospital between January 1 and December 31, 2003, to document cases of difficult intubation during anesthesia and to determine the cause(s), that the quality of service might be improved.  Patient data, corrective method, contributing factors, factors minimizing incidence and suggested corrective strategies were recorded on the ‘Difficult Intubation Record Form’.Results:  A total of 10 607 patients were included.  The incidence of difficult intubations during anesthesia was 20 (18.86 per 10 000; 95%CI 11.52, 29.11).  Corrective methods included:  stylet use, straight laryngoscope blade and intubation laryngeal mask airway.  Only minor physiological disturbances occurred in most patients.  The common contributing factors were:  insufficient knowledge, inexperience and insufficient equipment.  Suggested corrective strategies could include:  additional training, quality assurance activity, and purchase of equipment.Conclusion:  The incidence of difficult intubation was 18.86 per 10 000.  None of the patients experienced any major complications, perhaps because of standard anesthesia care.  The causes and corrective strategies comprised: patient character, personnel-associated, knowledge and equipment.  Additional equipment and training as well as quality assurance activity would probably help to reduce the incidence of difficult intubation. 

Incidence of Anesthesia-Associated Cardiac Arrest And Related Factors At Srinagarind Hospital

Objective:  To identify the incidence of anesthesia-related cardiac arrest complications and related factors.Design:  Prospective, descriptive study.Methods:  This was part of a multi-center study conducted by the Thai Royal College of Anesthesiologists for surveillance of anesthetic-related complications in Thailand in 2003.  We collected data from all of the cases receiving anesthesia service at Srinagarind Hospital between January 1 and December 31, 2003, to report the incidence of cardiac arrest and analyze the causes in order to improve the quality of service.  Events of cardiac arrest were reported by the attending anesthesia personnel and anesthesiologists.  All the forms were checked and verified by the principal author then included in the study.Results:  10,601 patients were included in this study.  The incidence of cardiac arrest was 47 (44.33 per 10,000 95%CI 32.59, 58.91).  The most common cause was hypotension (53.19%) while contributing factors included emergency situation (29.67%), poor patient preparation (16.48%), lack of experience (15.38%) and inappropriate decision-making (12.09%). The suggested corrective strategies were quality assurance activity and additional training.Conclusion:  The most common cause of cardiac arrest during anesthesia at Srinagarind Hospital was hypotension from massive blood loss.  Preventive and corrective strategies would include quality assurance activities that involve personnel development and the provision of sufficient equipment.