Extracorporeal cardiopulmonary resuscitation in a woman with twin pregnancy.

INTRODUCTION: Maternal cardiac arrest is a rare condition. Cardiopulmonary resuscitation (CPR) in pregnancy is different from that in other populations due to physiological changes in patients. Extracorporeal cardiopulmonary resuscitation (ECPR) is recommended in patients having cardiac arrest with potentially reversible etiologies. However, data regarding ECPR in pregnancy are limited. CASE SUMMARY: A 24-year-old woman with a 33-week twin pregnancy developed witnessed cardiac arrest in an antenatal clinic. She underwent perimortem cesarean delivery (PMCD) and ECPR, but uterine atony with massive bleeding occurred. Emergency hysterectomy and massive blood transfusion were performed in the emergency department and the patient was transferred to the intensive care unit after hemodynamics was stable. CONCLUSION: Cardiac arrest in pregnancy is a complex condition. Several aspects of management have not been evaluated. Prospective studies for improving the outcomes are needed.

Perioperative anaesthetic adverse events in Thailand (PAAd THAI) study: Incident report of perioperative convulsion.

The aim of this study was to identify the characteristics of perioperative convulsion and to suggest possible correcting strategies. The multi-centre study was conducted prospectively in 22 hospitals across Thailand in 2015. The occurrences of perioperative adverse events were collected. The data was collated by site manager and forwarded to the data management unit. All perioperative convulsion incidences were enrolled and analysed. The consensus was documented for the relevant factors and the corrective strategies. Descriptive statistics were used. From 2,000 incident reports, perioperative convulsions were found in 16 patients. Six episodes (37.5%) were related to anaesthesia, 31.3% to patients, 18.8% to surgery, and 12.5% to systemic processes. The contributing factor was an inexperienced anaesthesia performer (25%), while the corrective strategy was improvements to supervision (43.8%). Incidents of perioperative convulsion were found to be higher than during the last decade. The initiation and maintenance of safe anaesthesia should be continued.

The Thai Incident Monitoring Study (Thai AIMS) of suspected pulmonary embolism: an analysis of 1996 incident reports.

BACKGROUND: The present study is part of the multicenter study of model of anesthesia related adverse events in Thailand by Incident Report (The Thai Anesthesia Incident Mohitoring Study or Thai AIMS). The objectives of the present study were to determine the frequency clinical presenting, and outcomes of suspected pulmonary embolism. MATERIAL AND METHOD: The present study is a prospective descriptive research design. Three anesthesiologists extracted relevant data from the incident reports on suspected pulmonary embolism from the Thai AIMS database collected during the study period between January 1 and June 30, 2007. Descriptive statistics was used. RESULTS: After exclusion of four irrelevant or unlikely pulmonary embolism patients, there were 12 cases of suspected pulmonary embolism (0.6% of 1996 incident reports). Four cases (25%) were operated under emergency conditions. One incident (8.3%), eight incidents (67.7%), and three incidents (25%) were diagnosed by clinical diagnosis in preoperative, intra-operative, and 24-hour postoperative period. Common clinical manifestations were hypoxia (91.7%), hypotension (91.7%), and cardiac arrest (50%) at time of diagnosis. The mortality rate of obstetric surgery, orthopedic surgery, and general surgery were 42.8% (3 out of 7), 50% (2 out of4), and 0% (0 out of 1 patient) with a total mortality rate of 41.7%. Only two patients (16.6%) that had incidental cardiac arrest survived There were two cases (16. 6%) ofpreventable incidents due to incorrect usage ofpressure pump for rapid IV infusion. CONCLUSION: Diagnosis ofpulmonary embolism was difficult. The incidents were rare. Hypoxia and hypotension were the most common manifestations. Perioperative mortality rate was high (41.7%) despite prompt cardiopulmonary support. Most incidents were unexpected. An air embolism due to incorrect use of pressure pump for rapid IV infusion was considered preventable. Further epidemiologic studies for thromboembolism prophylaxis in Thailand are needed.

The Thai Anesthesia Incident Monitoring Study (Thai AIMS) of anesthetic equipment failure/malfunction: an analysis of 1996 incident reports.

BACKGROUND: The present study is a part of the multi-centered study of model of anesthesia relating adverse events in Thailand by incident report (The Thai Anesthesia Incident Monitoring Study or Thai AIMS). The objective was to identify the frequency distribution, contributing factors, and factors minimizing incident of equipment failure/malfunction. MATERIAL AND METHOD: As a prospective descriptive research design, anesthesia providers reported the data as soon as the incidents of equipment failure/malfunction occurred. Standardized forms of incident report were then mailed to the center at Chulalongkorn University and three anesthesiologists reviewed the data. RESULTS: Ninety-two cases of equipment failure/malfunction were reported from 51 hospitals across Thailand Between January and June 2007, 92 incidents of equipment failure/malfunction were reported out of 1996 anesthesia-related incidents (4.6%). Failed/malfunctioned equipment included anesthetic circuit (17.4%), anesthesia machine (15.2%), capnography (15.2%), laryngoscope (15.2%), ventilator (12%), pulse oximeter (8.7%), vaporizer (4.3%), endotracheal tube (3.3%), sodalime (3.3%), and electrocardiogram (2.2%). All 16 anesthetic circuit incidents (100%) were detected by clinical signs whereas five incidents (31.3%) were detected firstly by monitors. All 14 laryngoscope malfunction (100%) were detected solely by clinical signs. Only one out of eight (12.5%) of pulse oximeter incidents was detected by clinical signs before the pulse oximeter itself. Three out of four (75%) incidents of vaporizer were detected by clinical signs before monitors. The majority of equipment malfunction was considered as related to anesthetic (69.6%) and system factors (69.6%) and 71.7% of incidents were preventable. Seventy-four incidents (80.4%) were caused by human error and, specifically, rule-based error in three fourths. CONCLUSION: Contributing factors were ineffective equipment, haste, lack of experience, ineffective monitors, and inadequate equipment. Factors minimizing incidents were equipment maintenance, pre-use equipment checking, vigilance, prior experience, and compliance to guidelines. Suggested strategies were quality assurance activity, training, and improvement of supervision.

The Thai Anesthesia Incident Monitoring study (Thai AIMS): perioperative arrhythmia.

BACKGROUND: The Royal College of Anesthesiologists of Thailand organized the first national sentinel incident reports of anesthesia related adverse events in 2007 on an anonymous and voluntary basis. The aims of the present study were to analyze incidence, risk factors, clinical course and outcome of perioperative arrhythmia and indicate the contributing factors and suggested corrective strategies in the database of the Thai Anesthesia Incidents Monitoring Study (Thai AIMS). MATERIAL AND METHOD: This study was a prospective descriptive multicentered study conducted between January 2007 and June 2007. Data was collected from 51 hospitals across Thailand. All cases whose arrhythmia was detected intra-operatively and within 24 hr postoperative period were analyzed by 3 independents anesthesiologists. Any disagreements were discussed to achieve a consensus. RESULTS: Four hundred and eighty-nine cases were enrolled as relevant arrhythmia cases. Bradycardia was the most common type (434 cases; 88.8%). Most of all events occurred intra-operatively (94.7%) and electrocardiography was the most common firstly detected monitoring equipment (95.5%). Arrhythmia occurred frequently in patients with hypertension and pre-operative heart rate < 60 beat per min. Intravenous anesthetics, central neural blockage and vagal reflex were considered to be the 3 most common suspected causes of arrhythmia requiring treatment. Most common outcomes were minor physiologic change with complete recovery physiologic change with complete recovery while 7% of incidents developed fatal outcome. The most common contributing factor was human factor (72.4%) especially in experience. An experienced anesthetic team with high awareness could be the minimizing factors. CONCLUSION: Arrhythmia accounted for 19.2% of 2,537 incidents of the Thai AIMS database. Bradycardia was the most common type of cardiac arrhythmia. Most arrhythmia was benign but might be fatal. Suggested corrective strategies such as guidelines practice, improvement of supervision and quality assurance activity.

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.

Effect of parecoxib on postoperative pain after lumbar spine surgery: a bicenter, randomized, double-blinded, placebo-controlled trial.

STUDY DESIGN: A bicenter randomized, patients, healthcare providers, and data collectors blind placebo-controlled trial in multimodal analgesia for postoperative lumbar spine surgery was conducted. OBJECTIVE: To assess the efficacy and safety of parecoxib on postoperative pain management after posterior lumbar spine surgery. SUMMARY OF BACKGROUND DATA: Systematic reviews suggest that cyclo-oxygenase-2 inhibitors are an effective treatment for acute postoperative pain. However, previous trials on lumbar spine surgery showed equivocal efficacy of cyclo-oxygenase-2 inhibitors for postoperative pain relief. METHODS: In this study, 120 patients undergoing posterior lumbar discectomy, spinal decompression, or spinal fusion were stratified based on the surgical procedure to 3 groups (n = 40) and randomly allocated to receive multidoses of parecoxib 40 mg/dose or placebo. Efficacy was assessed by total morphine used from patient-controlled analgesic pump, pain intensity, pain relief, and the patient's subjective rating of the medication. RESULTS: Parecoxib 40 mg reduced the total amount of morphine required over 48 hours by 39% relative morphine reduction compared with placebo (P = 0.0001). Pain at rest was reduced by 30% (P = 0.0001). Ninety percent of patients given parecoxib experienced at least 50% maximum total pain relief compared with 58% treated with placebo. The number-needed-to-treat for 1 patient to have at least half pain relief was 3.1 (2.0-4.6). Patients' subjective rating of the medication was described as "excellent, good, and fair" by 48%, 43%, and 8% in the parecoxib group, respectively, compared with 21%, 50%, and 28% of placebo patients (P = 0.004). Overall adverse effects of patients receiving parecoxib and morphine were comparable to those receiving morphine alone. CONCLUSION: The present study demonstrates that the perioperative administration of parecoxib with patient-controlled analgesic morphine after lumber spine surgery resulted in significantly improved postoperative analgesic management as defined by reduction in opioid requirement, lower pain scores, and higher patients' subjective rating of the medication.

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.

Predictors of intra-operative recall of awareness: Thai Anesthesia Incidents Study (THAI Study): a case-control study.

BACKGROUND: The authors determined predictors of intra-operative recall of awareness in the Thai Anesthesia Incidents Study (THAI Study). OBJECTIVE: To study a multi-centered registry of anesthesia in 20 hospitals across Thailand. MATERIAL AND METHOD: Structured data collection forms of patients who underwent general anesthesia and experienced intra-operative recall of awareness between March 1, 2003 and February 28, 2004, were reviewed by three independent anesthesiologists. One case of awareness was matched to four controls by age, gender, and level of hospitals. Univariate analysis (p < 0.1) and logistic regression (p < 0.05) identified characteristics associated with intra-operative recall of awareness. RESULTS: Eighty-one cases were matched with 324 controls in the nested case control study. From univariate analysis, risk factors were cardiac surgery, cesarean delivery, upper abdominal surgery, i.v. anesthetics, depolarizing muscle relaxant, non-depolarizing muscle relaxant, and nitrous oxide (p < 0.1). The predictors from multivariable logistic regression were cesarean delivery p < 0.001, OR 6.48 (95% CI 2.03, 20.71), and cardiac surgery p < 0.001, OR 10.37 (95% CI 3.37, 31.89). Decreased risk was associated with intra-operative use of nitrous oxide p = 0.02, OR 0.42 (95% CI 0.20, 0.88). CONCLUSION: In the THAI Study, predictors of intra-operative recall of awareness were cesarean delivery and cardiac surgery. Use of nitrous oxide attenuates the risk of awareness.

Successful separation of thoracopagus conjoined twins with a single extra-hepatic biliary system.

A pair of thoracopagus conjoined twins were separated at the age of 3 months at Khon Kaen Regional Hospital, Thailand on November 19, 2004. Pre-operative investigations showed separate hearts, joined duodenum, and fusion of the livers. Separation of the extra-hepatic biliary systems was suspected. Operative findings revealed fusion of the intestines from the second part of the duodenum to the terminal ileum with two normal colons. An intussusception was found at the terminal ileum. Fusion of the livers with only one extra-hepatic biliary system was noted In one of the twins, the gastrointestinal tract was anastomosed with Roux-en- Y enteric loop to one area of good bile drainage at the cut surface of liver Post operative course was hectic but both twins recovered satisfactorily. Both are doing well at present, two years after the separation. This was the first reported case of thoracopagus conjoined twins with complex biliary tract anomalies in Thailand. From the literature, pre-operative investigations in most cases of these conjoined twins failed to define the precise anatomy of the biliary system and may be misleading as in the presented case. The mortality rate remains high. Meticulous pre-operative planning, decision-making in the operative field and postoperative management as well as a multidisciplinary team are very important for a successful separation.

The Thai Anesthesia Incidents Study (THAI Study) of oxygen desaturation.

OBJECTIVES: To examine incidents, contributory factors, treatment and outcomes associated with oxygen desaturation during anesthesia practice in Thailand. MATERIAL AND METHOD: Relevant data were extracted from the Thai Anesthesia Incidents Study (THAI Study) database between February 1, 2003 and January 31, 2004 and analyzed by using mainly descriptive statistics. RESULTS: Four hundred and ninety seven incidents of oxygen desaturation (SpO2 <90 for at least 3min or < or = 85%) were reported. The incidents were widely distributed throughout anesthesia phases. Most of the incidents (92.2%) occurred during general anesthesia, while 23 (4.6%) occurred after regional anesthesia. Anesthesia was the sole contributory factor in 280 patients (56.8%) and a combination of that with other factors in 126 (25.4%). The majority of the incidents (88.4%) was related to respiratory adverse events, whereas, 8% was related to circulatory ones. Sixteen incidents (3.2%) were related to anesthetic machine and equipment failure. Most of the incidents (60.0%) caused minor physiologic changes and were correctable. The management was considered adequate in the majority of patients. As a result, 77.5 % of the patients recovered completely, whereas, death ensued in 5.8%. The cases of death were associated with co-morbidity (ASA class 4 and 5) with an Odds ratio of 12.9 (95% CI:5.4,31.0). The common contributory factors were inexperience, wrong decision, inadequate knowledge and lack ofsupervision. The proposed corrective strategies included improvement in supervision, care improvement, additional training, clinical practice guideline and quality assurance activity. CONCLUSION: Incidents associated with oxygen desaturation were distributed throughout all phases of anesthesia. Most of them were preventable and correctable. Therefore, anesthesia care providers should be alert in looking for incidents, and manage them promptly before they were in serious adverse events.

The Thai Anesthesia Incidents Study (THAI Study) of anesthetic equipment failure/malfunction: a qualitative analysis for risk factors.

BACKGROUND: Anesthesia equipment problems may contribute to anesthetic morbidity and mortality. In Thailand, the magnitude and pattern of these problems has not been established. We therefore analyzed the frequency, type and severity of equipment-related problems, and what additional efforts might be needed to improve safety. MATERIAL AND METHOD: The data were drawn from the Thai Anesthesia Incidents Study (THAI Study) between February 1, 2003 and July 31, 2004 in which anesthesia-related data (i.e. of perioperative problems and their severity) were recorded (by the attending anesthesiologist) from all anesthetic cases on a routine basis. We selected cases under general and regional anesthesia with anesthetic equipment failure/malfunction for descriptive analysis. RESULTS: The frequency of anesthetic equipment problems of the 202,699 recorded cases was approximated 0.04% or 1 : 2252. Two-thirds of the problems (63%) involved the anesthesia machine and of these incidents 73 and 41 percent involved system and human errors, respectively. One patient died and one suffered permanent morbidity. CONCLUSION: The incidence and severity of equipment problems was low. Aside from improvements to pre-operative equipment checks, vigilance, continuous quality improvement and quality assurance activities were suggested as strategies to reduce problems.

The Thai Anesthesia Incidents Study (THAI Study) of perioperative death: analysis of risk factors.

BACKGROUND: National statistical data of mortality and morbidity related to anesthesia have not been reported. The need to comprehensively examine the cause of death as well as other adverse events prompted the first national study in Thailand. MATERIAL AND METHOD: In the Thai Anesthesia Incidents Study (THAI Study), a prospectively defined cohort of patients who underwent anesthesia from February 1, 2003 to January 31, 2004 (n=163,403) was studied. All consecutive patients who died intraoperatively or within the period of 24 hr after anesthesia were classified to determine a relationship with anesthesia by 3 independent reviewers. These data were further analysed to identify contributing factors. RESULTS: The incidence of 24-hr perioperative death, anesthesia directly related and anesthesia partially related death per 10,000 anesthetics was 28.2 (95% CI 25.7-30.8), 1.7 (95% CI 1.1-2.3) and 4.0 (95% CI 3.1-5.0) respectively. Of 462 deaths, 28 cases (6.5%), 66 cases (14.3%), 61 cases (3.3%), 399 cases (86.7%) and 104 cases (22.6%) were anesthesia directly related, anesthesia partially related, surgical related, patient disease related and system or management related to perioperative death. The common main causes of death were exangination (42.4%), traumatic brain injury (14.3%), sepsis (13.6%), heart failure (5.0%) and hypoxia (5.0%). CONCLUSION: This study shows incidence of 24-hr perioperative death of 1:354 which is comparable with other studies. Quality assurance activity, prevention of human failure and equipment failure, system improvement of perioperative care, availability of recovery room, intensive care unit, efficient blood bank and adequate number of MD. anesthesiologists are suggestive corrective strategies.

The Thai Anesthesia Incidents Study (THAI Study) of anesthesia personnel hazard.

OBJECTIVES: To determine the incidence, causes, management, outcomes and corrective strategies for personnel hazard in Thai Anesthesia Incidents Study (THAI Study). MATERIAL AND METHOD: Personnel hazard incidents were extracted from the Thai Anesthesia Incidents Study (THAI Study) database conducted between February 1, 2003 and January 31, 2004 and analysed using descriptive statistics. RESULTS: Twenty-four incidents of personnel hazard were recorded. Majority of incidents occurred in nurse anesthetist (54.2%). Five incidents exposed to patient blood but no infection reported afterwards. Nineteen incidents (79.2%) were injury without contact to patients blood or body fluid. Most of them were injured by broken ampoules. One case needed to leave from work for a while due to hand dysfunction. CONCLUSION: Personnel hazard incidence were quite low frequency because of under-report. One case of morbidity was reported. Universal precaution and post exposure prophylaxis tended to minimize the risk of infection.

The Thai Anesthesia Incidents Study (THAI Study) of perioperative allergic reactions.

OBJECTIVES: To determine the incidence, risk factors, signs, symptoms and management of perioperative allergic reactions in the Thai Anesthesia Incidents Study (THAI Study). MATERIAL AND METHOD: Between February 1, 2003, and January 31, 2004, a descriptive, prospective, multicenter study was conducted in 20 hospitals across Thailand. All patients receiving anesthetic and medical agents were monitored for allergic reactions for the first 24 postoperative-hours. Signs and symptoms of suspected allergic reactions included skin reactions, wheezing and unexpected hypotension. The details of allergic reactions were reviewed and recorded. RESULTS: Allergic reactions occurred in 30 of the 163,403 patients included in this study. The reaction-incidence was approximately 1 in 5,500 cases of anesthesia. Forty-eight percent of the affected patients had a history of allergic reactions. The manifestations were skin reactions, hypotension and wheezing in 38, 22 and 19 percent of the overall symptoms, respectively. Reactions were mild, moderate and severe in 40, 23 and 37 percent of the patients, respectively. The three drugs most suspected of causing the reaction(s) were antibiotics (19%), muscle relaxants (17%) and propofol (15%). All of the affected patients recovered after treatment including the one who suffered cardiac arrest because of the allergic reaction. CONCLUSION: The incidence of perioperative allergic reactions was 1 in 5,500 cases of anesthesia. History of allergies was obtained from half of the patients and the most common sign was a skin reaction. The drugs most suspected of causing an allergic reaction were antibiotics. All of the patients responded well to rescue treatment.

Malignant hyperthermia: a case report in Thai Anesthesia Incidents Study (THAI Study).

A 3-year-old Thai boy underwent open reduction and internal fixation with K-wire of condylar fracture of humerus under general anesthesia. The patients developed generalized muscle regidity, masseter muscle spasm, elevated creatinine kinase, high temperature (39.3 C), inappropriate tachycardia, and arterial base excess was more than-8 mEq/L. The clinical grading scale of diagnosis of malignant hyperthermia was 58 (grade D6; almost certain malignant hyperthermia). Succinylcholine has been identified as the trigger agent, as other possible trigger agents were not involved. The treatment included hyperventilation, external cooling and cold IV fluids without administration of dantrolene. The patient fully recovered and discharged on day 12. This case report showed an incidence of malignant hyperthermia of approximated 1:150,000 in Thai Anesthesia Incidents Study (THAI Study).