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The Thai Anesthesia Incidents Study (THAI Study) of Oxygen Desaturation

Yodying Punjasawadwong, MD*, Thitima Chinachoti MD**, Somrat Charuluxananan MD*** Aksorn Pulnitiporn MD****, Sireeluck Klanarong MD***** Waraporn Chau-in MD******, Oraluxna Rodanant MD***

Affiliation : * 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, Chulalongkorn University, Bangkok. **** Department of Anesthesiology, Khon Kaen Regional Hospital, Khon Kaen. ***** Department of Anesthesiology, Buddhachinaraj Regional Hospital, Phitsanulok. ****** Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Objectives : To examine incidents , contributory factors, treatment and outcomes associated with oxygen desaturation during anesthesia practice in Thailand.
Materials and Methods : 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 statis- tics.
Results : Four hundred and ninety seven incidents of oxygen desaturation (SpO2 <90 for at least 3min 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, inad- equate knowledge and lack of supervision. The proposed corrective strategies included improvement in super- vision, care improvement, additional training, clinical practice guideline and quality assurance activity.
Conclusion : Incidents associated with oxygen desaturation were distributed throughout all phases of anesthe- sia. 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.

Keywords : Oxygen desaturation, Hypoxemia, Anesthesia, Incidents, Complications


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JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND
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JMed Assoc Thai
MEDICAL ASSOCIATION OF THAILAND
ISSN: 0125-2208 (Print),
ISSN: 2408-1981 (Online)
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