Cardiac Arrest and Complications after Spinal Anesthesia:
The Perioperative and Anesthetic Adverse Event in
Thailand (PAAd Thai) Incident Report Study
Dujduen Sriramatr MD¹, Wanida Chongarunngamsang MD¹, Prae Plansangkate MD², Prok Laosuwan MD³,
Somrat Charuluxananan MD³, Sasikaan Nimmaanrat MD², Thanist Pravitharangul MD⁴, Wanna Angkasuvan MD⁵
Affiliation :
¹ Department of Anesthesiology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand ² Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand ³ Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand ⁴ Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ⁵ Department of Anesthesiology, Hatyai Hospital, Songkhla, Thailand
Background : Spinal anesthesia is one of most common anesthetic techniques in Thailand. The Perioperative and Anesthetic Adverse Events in
Thailand (PAAd Thai) Study was a multicentered project among 22 hospitals across the country to investigate the incidence of anesthesia related
complications.
Objective : To study the incidences of cardiac arrest and complication after spinal anesthesia including the contributing factors and suggested corrective strategies. Materials and Methods : This prospective descriptive study of the incident reports that occurred regarding spinal anesthesia collected from 22 participating hospital in the data collection between January and December of 2015 was completed. Three senior anesthesiologists reviewed the data and descriptive statistics were used.
Results : Among 62,120 spinal anesthesia, there were 127 incidents (5.8%) among 2,206 incident reports related to anesthesia. There were seven cases of intraoperative cardiac arrest with an incidence of 1.13:10,000 spinal anesthesia (95% CI 0.55 to 2.33). Other complications were bradycardia with less than 40 beats per minute (50.4%), anaphylaxis or anaphylactoid reaction or drug allergy (14.2%), drug error (8.4%), coma or CVA or convulsion (3.9%), and suspected pulmonary embolism (3.9%). Adverse events occurred frequently with specialties or surgeries of orthopedics (44.1%), cesarean delivery (17.3%), urosurgery (17.3%), general surgery (14.2%), and gynecological surgery (4.7%), respectively.
Conclusion : Contributing factors were inexperience, inappropriate decision making, haste, and inappropriate pre-anesthetic evaluation or preparation while factors minimizing incidents were vigilance, having experience, and experienced assistants. Suggested corrective strategies were quality assurance activity, guidelines especially monitoring, improvement of supervision, and additional training.
Received 23 December 2020 | Revised 26 January 2021 | Accepted 26 January 2021
doi.org/10.35755/jmedassocthai.2021.04.12401
Keywords :
Spinal anesthesia, Adverse events, Incidents, Complications, Neuraxial anesthesia, Cardiac arrest
All Articles
Download