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The Thai Anesthesia Incidents Study (THAI Study) of Pulmonary Aspiration : A Qualitative Analysis

Suwannee Suraseranivongse MD*, Songyos Valairucha MD*, Thavat Chanchayanon MD**, Niran Mankong MD***, Thewarug Veerawatakanon MD****, Mali Rungreungvanich MD*****

Affiliation : *Department of Anesthesiology, Siriraj Hospital, Mahidol University ** Department of Anesthesiology, Songklanagarind Hospital, Prince of Songkla University, Songkhla *** Department of Anesthesiology, Buddhachinaraj Hospital Phitsanulok **** Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University ***** Department of Anesthesiology, Ramathibodi Hospital, Mahidol University, Thailand

Objectives : To examine the risk factors, outcomes, and contributing factors associated with perioperative pulmonary aspiration.
Materials and Methods : Pulmonary aspiration incidents were extracted from the Thai Anesthesia Incidents Study (THAI Study) database conducted between March 1, 2003, and February 28, 2004, and analyzed using descriptive statistics.
Results : Thirty — two incidents of aspiration were reported. Passive regurgitation occurred more frequently than active vomiting. Aspiration occurred more commonly in elective rather than emergency surgery, with 59% of incidents taking place during the induction of anesthesia and intubation period. While a major immediate physiological disturbance was common, long term morbidity was not. Death ensued in 5 cases, most of which had significant co — morbidities. Most cases (62.5%) were appropriately treated. The majority of incidents occurred in ASA class 2 (56.3%), age group 15 — 64 years (59.4%), non obese (92.9%) and non — difficult intubation (71.9%). Most cases were incomplete fasted or had prolonged gastric emptying time. Nasogastric aspiration and rapid sequence induction with cricoid pressure were infrequently used (12.5, 25%). Factors reported as contributing to the incidents included failure of technique and error of judgement. Additional training, continuing medical education and quality assurance tended to minimize the incidents.
Conclusion : Aspiration occurred commonly in patients with incomplete fasted or had prolonged gastric emptying time and underwent elective surgery. Additional training, continuing medical education and qual- ity assurance tended to minimize the incidents.

Keywords : Pulmonary aspiration, Anesthesia, Multicenter study, Complication, Adverse outcomes


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