The Thai Anesthesia Incident Monitoring Study (Thai AIMS) of endobronchial intubation: an analysis of 1996 incident reports.

OBJECTIVE: To analyze the clinical course, outcomes, contributing factor, corrective and preventive strategies of accidental endobroncheal intubation (EBI) in the Thai Anesthesia Incident Monitoring Study (Thai AIMS). MATERIAL AND METHOD: This was a prospective descriptive multicenter study of anesthesia-related adverse incidents from 51 hospitals across Thailand from January to June 2007. Possible accidental EBI data were extracted and analyzed using descriptive statistics by 3 reviewers. RESULTS: Thirty-two cases (1.6%) of EBI were reported from a total of l996 Thai AIMS incidents. EBI occurred more often in females (71.9%). Most of the incidents happened in the operating theater (93.8%) and the most common surgical specialties were general and gynecological surgery (20.6% each). Two cases had hypoxemia and 1 case required respiratory supported postoperatively. Most incidents (65.6%) were first recognized via monitoring equipment which was detected by pulse oximeter (71.4%) and airway pressure measurement (4.8%). Ninety six percent of cases were considered preventable. Anesthetic factors and system factors were found to involve in 62.5% and 11.8% of incidents respectively. The major contributing factors were inexperience of the performers (84.4%), lack of knowledge (40.6%), haste (21.9%) and communication failure (9.4%). The incident would be minimized by having prior experience of incident, high awareness and experienced assistants available. Three main strategies to prevent the incident included additional training, improvement supervision and established guideline practice. CONCLUSION: Accidental endobronchial intubation was reported as 1.6% of anesthetic adverse event in Thai AIMS. Majority of the incidents were contributed by anesthesia and system factors. High awareness, experience of performers and additional training would decrease the incidents and improve anesthetic outcome.

Multicentered study of model of anesthesia related adverse events in Thailand by incident report (The Thai Anesthesia Incidents Monitoring Study): results.

OBJECTIVE: The Thai Anesthesia Incidents Monitoring Study (Thai AIMS) was aimed to identify and analyze anesthesia incidents in order to find out the frequency distribution, clinical courses, management of incidents, and investigation of model appropriate for possible corrective strategies. MATERIAL AND METHOD: Fifty-one hospitals (comprising of university, military, regional, general, and district hospitals across Thailand) participated in the present study. Each hospital was invited to report, on an anonymous and voluntary basis, any unintended anesthesia incident during six months (January to June 2007). A standardized incident report form was developed in order to fill in what, where, when, how, and why it happened in both the close-end and open-end questionnaire. Each incident report was reviewed by three reviewers. Any disagreement was discussed and judged to achieve a consensus. RESULTS: Among 1996 incident reports and 2537 incidents, there were more male (55%) than female (45%) patients with ASA PS 1, 2, 3, 4, and 5 = 22%, 36%, 24%, 11%, and 7%, respectively. Surgical specialties that posed high risk of incidents were neurosurgical, otorhino-laryngological, urological, and cardiac surgery. Common places where incidents occurred were operating room (61%), ward (10%), and recovery room (9%). Common occurred incidents were arrhythmia needing treatment (25%), desaturation (24%), death within 24 hr (20%), cardiac arrest (14%), reintubation (10%), difficult intubation (8%), esophageal intubation (5%), equipment failure (5%), and drug error (4%) etc. Monitors that first detected incidents were EKG (46%), Pulse oximeter (34%), noninvasive blood pressure (12%), capnometry (4%), and mean arterial pressure (1%). CONCLUSION: Common factors related to incidents were inexperience, lack of vigilance, inadequate preanesthetic evaluation, inappropriate decision, emergency condition, haste, inadequate supervision, and ineffective communication. Suggested corrective strategies were quality assurance activity, clinical practice guideline, improvement of supervision, additional training, improvement of communication, and an increase in personnel.

Prevention of post operative pain after abdominal hysterectomy by single dose etoricoxib.

OBJECTIVE: To test whether a reduction in post operative morphine consumption could be achieved by a single-dose of etoricoxib before induction of anesthesia. DESIGN: Randomized, double-blind, placebo-controlled study. MATERIAL AND METHOD: Two hours before surgery, patients undergoing transabdominal hysterectomy (under general anesthesia) were randomized to a single oral dose of 1) etoricoxib 120 mg (n = 17), 2) etoricoxib 180 mg (n = 17), or 3) placebo (n = 15). Intravenous morphine was given for patient-controlled analgesia (PCA) device. Morphine consumption, pain scores both at rest and on coughing, and side-effects were recorded at 1, 2, 4, 8 and 24 h after surgery. Patients' global evaluation of study medication was assessed at the end of the present study. RESULTS: Etoricoxib provided greater clinical benefit than the placebo in terms of mean morphine in milligram at 24 hour consumption (stardard deviation): a) 26.4 mg (SD of 11.2) for etoricoxib 120 mg; b) 27.2 mg (SD of 9.9) for etoricoxib 180 mg; and, c) 36.6 mg (SD of 8.9) for the placebo group. At 8 h post surgery, pain both at rest and on coughing in the active drug groups was significantly less than in the placebo, while pain on coughing was significantly less at 24 h. Patients reported better global satisfaction and less somnolence in the etoricoxib groups. CONCLUSION: Single dose etoricoxib 180 mg given before surgery provides the same analgesic effect as 120 mg for post operative pain after an abdominal hysterectomy.