The Thai Anesthesia Incident Monitoring Study (Thai AIMS): An Analysis of 21 Awareness Events
Phuping Akavipat MD*, Pimwan Sookplung MD*, Pornthep Premsamran MD**, Patiparn Toomtong MD***, Chaiyapruk Kusumaphanyo MD****, Patcharin Muansaiyart MN*****
Affiliation : * Department of Anesthesiology, Prasat Neurological Institute, Bangkok, Thailand ** Department of Anesthesiology, Chulalongkorn University, Bangkok, Thailand *** Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand **** Department of Anesthesiology, Srinakharinwirot University, Bangkok, Thailand ***** Department of Academic Services, Prasat Neurological Institute, Bangkok, Thailand
Objective : To demonstrate the characteristics, outcomes, and the circumstances associated with intraoperative
recall of awareness
Material and Method: Relevant data of intra-operative recall of awareness were extracted from the Thai
Anesthesia Incident Monitoring study (Thai AIMS) database of 1996 incident reports and 2537 incidents
which were conducted among 51 hospitals throughout Thailand from January to June, 2007. Details regarding
patients, surgical, anesthetic and systematic factors were recorded in a structured data record form. The
completed record forms were reviewed independently by three anesthesiologists. The descriptive statistic was
analyzed by using SPSS software version 11.5 and demonstrated in number and percent.
Results : Twenty-one incidents (21/1996 = 1.05%) of intra-operative recall of awareness were reported.
Awareness was predominantly found in females (76.2%) and with ASA physical status I (47.6%). Most of the
patients recalled events during the maintenance period and reported sound (71.4%), pain (52.4%), feeling
operated (38.1%), paralysis (33.3%), recognizing intubated (4.8%) and panic (4.8%). Anxiety (33.3%),
temporary emotional stress (19%), and post traumatic stress (4.8%) were found during immediate outcome
assessment but scarcely sustained on the hospital discharged date. The factors associated with the incidents
were anesthetic related in the majority especially ineffective monitoring (100%), pre-medication abandonment
(100%) and light anesthesia (71.5%).
Conclusion : Intra-operative recall of awareness in the Thai AIMS was 1.05% of all incident reports. Most of
the events were considered as anesthesia related. The suggested corrective strategies were quality assurance
activity, effective monitoring and equipment maintenance.
Keywords : Intra-operative, Recall, Adverse event, Awareness, Anesthesia, Complications
