Perioperative non-hypoxic bradycardia in pediatric patients: Thai anesthesia incident monitoring study (Thai AIMS)

ABSTRACT

Background: The Royal College of Anesthesiologists of Thailand arranged the first national incident reports of anesthesia-related adverse events in 2007 on an anonymous and voluntary basis. Objective: To identify the incidence of perioperative non-hypoxic bradycardia in pediatric patients’ clinical course, outcome, contributing factors and its preventive strategies in the database of the Thai anesthesia incidents monitoring study (Thai AIMS). Methods: As part of the Thai AIMS, perioperative anesthesia incident reports of adverse events were collected from 51 participating hospitals across Thailand between January to June 2007. Three anesthesiologists reviewed relevant data of perioperative non-hypoxic bradycardia in pediatric patients. A descriptive statistical method was used. Results: There were 49 cases of perioperative non-hypoxic bradycardia in pediatric patients (2.4% of all 1996 incident reports or 13.4% of all incident reports from pediatric patients). Anesthesia (71%) was a major factor that related to the bradycardia, wheareas 19% and 10% were surgical and patient factors, respectively. Sixty percent of cases occurred during induction, of which 80% (24 out of 30 cases) and 10% were considered as anesthesia-related or combination of anesthesia and patient factors. Sixty percent (9 out of 15 cases) of bradycardia during the maintenance phase was surgery-related particularly in ophthalmologic surgery. Four cases (8.1%) of all bradycardia occurred during the emergence and recovery phase of which 78% was considered anesthesia-related. All bradycardia had complete recovery. Sixty-three percent of events were preventable. Major contributing factors were lack of adequate knowledge (55%) and inappropriate decision-making (22%). Conclusion: Most perioperative non-hypoxic bradycardia incidences were anesthesia-related and most common during the induction phase. Improved supervision, additional training and vigilance were suggested corrective strategies.