Perioperative Stroke and Coma in Thai Anesthesia Incidents Study (THAI Study)
Varinee Lekprasert MD *, Phuping Akavipat MD **, Chomchaba Sirinan MD*, Surirat Srisawasdi MD*
Affiliation : * Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400 ** Department of Anesthesiology, Prasat Neurological Institute, Bangkok 10400, Thailand
Objectives : To analyze perioperative stroke and coma using database of Thai Anesthesia Incidents Study (THAI
Study) with regard to frequency, contributing factors, preventive and corrective strategies.
Materials and Methods : Details of perioperative neurological complications comprising stroke and coma in
one year were recorded prospectively by attending anesthesiologists or nurse anesthetists in standardized
record forms. All data were analyzed to identify contributing factors and preventive strategies.
Results : Among 172,592 anesthetics, there were 24 cases of coma, and 28 cases of stroke. Most cases of coma
that eventually died (12/16 cases, 75%) had ASA physical status (ASA PS) ranging from 2E to 5E. Perioperative
stroke was found mainly in patients with ASA PS 3 and most of the incidence (74%) occurred in patients who
had no previous history of stroke. These patients already had pre-existing cardiovascular diseases and
underwent high risk procedures. There were 54% of perioperative stroke cases that could be due to improper
cardiovascular management and 42% due to improper emergency neurological management.
Conclusion : The incidence of perioperative stroke and coma in this study was approximately 0.03%. The
majority of cases had no prior stroke or coma, which suggested that a problem during perioperative period
itself might predispose patients to these complications. Preventive strategies included quality assurance
activity, improved communication, and practice guideline.
Keywords : Perioperative stroke, Coma, Anesthesia
