The Thai Anesthesia Incidents Study (THAI Study) of Anesthetic Outcomes : II Anesthetic Profiles and Adverse Events
Somrat Charuluxananan MD*, Yodying Punjasawadwong, MD**, Suwannee Suraseranivongse MD***, Surirat Srisawasdi MD****, Oranuch Kyokong MD*, Thitima Chinachoti MD***, Thavat Chanchayanon MD*****, Mali Rungreungvanich MD****, Somboon Thienthong MD******, Chomchaba Sirinan MD****, Oraluxna Rodanant MD*
Affiliation : * Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok. ** Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai. *** Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok. **** Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok. ******** Department of Anesthesiology, Prince of Songkla University, Songkhla. ****** Department of Anesthesiology, Khon Kaen University, Khon Kaen, Thailand
Background and rationale : The purposes of the Thai Anesthesia Incidents Study (THAI Study) of anesthetic
outcomes were to survey patients, surgical, anesthetic profiles and determine factors related to adverse events.
Materials and Methods : A prospective descriptive study of occurrence screening was conducted in 20 hospitals
comprised of 7 university, 4 general and 4 district hospitals across Thailand. Anesthesia personnel were
required to fill up patient-related, surgical-related, anesthesia-related variables and adverse outcomes on a
structured data entry form. The data were collected during the preanesthetic evaluation, intraoperative period
and 24 hr postoperative period. Adverse events specific forms were used to record when they occurred. All data
were keyed at data management unit with double entry technique and descriptive statistics was used in the first
phase of this study.
Results : A total of 163403 consecutive cases were recorded during first 12 months. MD. anesthesiologists
involved with 82%, 89%, 45% and 0.2% of cases in university hospitals, regional hospitals, general hospitals
and district hospitals respectively. Nurse anesthetists took a major involvement in hospitals run by the Ministry
of Public Health. Two-thirds of cases did not receive any premedication (67%) and midazolam was most fre-
quent premedication administered (20%). Common monitoring were non invasive blood pressure (NIBP) (97%),
pulse oximetry (96%), electrocardiography (80%), urine output (33%), airway pressure (27%) and capnometry
(19%) respectively. The choices of anesthesia were general anesthesia (62%), spinal anesthesia (23%), total
intravenous anesthesia (6%), monitor anesthesia care (4%), brachial plexus block (3%) and epidural anesthe-
sia (1%). The adverse events were oxygen desaturation (31.9:10000), cardiac arrest (30.8:10000), death within
24 hr. (28.3:10000), difficult intubation (22.5:10000),re-intubation (19.4:10000), unplanned ICU admission
(7.2:10000), coma/cva/convulsion (4.8:10000), equipment malfunction/failure (3.4:10000), suspected myocar-
dial ischemia or infarction (2.7:10000), awareness during anesthesia (3.8:10000), late detected esophageal
intubation (4.1:10000), failed intubation (3.1:10000), anaphylaxis or anaphylactoid reaction (2.1:10000), nerve
injury (2:10000), pulmonary aspiration (2.7:10000), drug error (1.3:10000), hazard to anesthesia personnel
(1.5:10000), unplanned hospital admission (0.1:10000), total spinal block (1.3:10000) and mismatch blood
transfusion (0.18:10000)
Conclusion : Respiratory adverse events were common anesthesia direct related events. High incidence of
cardiac arrest and death within 24 hr. highlighted concerns for prevention strategies. Incidents of adverse
events can be used for institutional quality improvement, educational quality assurance and further research
for patient safety in anesthesia.
Keywords : Anesthesia, Complications, Adverse events, Quality, Safety, Outcome
