An Analysis of Intraoperative Recall of Awareness in Thai Anesthesia Incidents Study (THAI Study)
Mali Rungreungvanich MD*, Varinee Lekprasert MD, MSc(Epidemiology)*, Chomchaba Sirinan MD, MPH*, Thanoo Hintong MD**.
Affiliation : Department of Anesthesiology, Faculty of Medicine, * Ramathibodi Hospital, Mahidol University, **Chiang Mai University, Thailand
Objectives : This study aimed to analyze intraoperative awareness using database of Thai Anesthesia Inci-
dents Study (THAI Study) with regard to frequency, contributing factors, preventive and corrective strategies.
Materials and Methods : Details of intraoperative recall of awareness were recorded prospectively by attend-
ing anesthesiologists or nurse anesthetists in standardized record forms during February 1,2003 to July 31,
2004. Participating hospitals included 7 university hospitals, 5 tertiary care hospitals, 4 secondary care
hospitals, and 4 primary care hospitals. All data were analyzed to identify contributing factors, preventive
and corrective strategies.
Results : Among 126078 general anesthetized cases, there were 99 cases of intraoperative recall of awareness.
Awareness was found in female patients more than male patients (63% versus 37%). The majority of patients
had ASA PS 1 and 2. Cardiac, obstetric, and lower abdominal surgery were involved in anesthesia awareness
more than other type of surgery. Patients experiencing awareness reported sound (62%), pain (51%), feeling
operated without pain (33%), and paralysis (25%). There was slight impact of anesthesia awareness in Thai
patients (only 13% had temporary emotional stress and 13% had mild anxiety) despite small percentage of
proper management by reassurance and psychiatric consultation (15%). The contributing factors included
inadequate knowledge (67%), inadequate medication dosage (44%), and inadequate care from inexperience
(11%). Awareness incidents were documented to be preventable in 36% of patients and partially preventable
in 38 % of patients. The corrective strategies included guideline practice (30%), additional training (28%),
quality assurance activity (19%), and improved supervision (16%).
Conclusion : The incidence of intraoperative recall of awareness in this study was 0.08%. Patients reported
sound, pain, feeling operated without pain, and paralysis. Corrective strategies included guideline practice,
additional training, quality assurance activity, and improved supervision.
Keywords : Anesthesia, Intraoperative, Recall, Awareness
