Perioperative pulmonary aspiration: an analysis of 28 reports from the Thai Anesthesia Incident Monitoring Study (Thai AIMS).

OBJECTIVE: To study the patients' characteristics, outcomes, contributory factors, factors minimizing the incidence and suggested corrective strategies for perioperative pulmonary aspiration in Thailand. MATERIAL AND METHOD: This is a prospective descriptive research design. The relevant data was extracted from the incident reports on aspiration from 51 hospitals across Thailand during the study period between January 1 and June 30, 2007 from the Thai Anesthesia Incident Monitoring Study (Thai AIMS) database. Descriptive statistics was used. Each incident report was reviewed by three senior anesthesiologists. Any disagreement was discussed to achieve a consensus. RESULTS: From 1,996 incident reports, there were 28 reports (1.4%) that met the definition of pulmonary aspiration. Most of the incidents occurred in patients with ASA 1-2 (85.7%), during the official hour (64.3%) and the anesthesiologists were in charge (67.9%). Eleven incidents (39.3%) occurred during induction, seven (25%) during maintenance and seven (25%) during emergence phases. Anesthetic factors played an important role in 26 incidents (92.9%). All the incidents except one (96.4%) were considered human errors and 25 (89.2%) were preventable. Of the incidents caused by human errors, nine (32.1%) were caused by skill-based errors. Thirteen patients (46.4%) had major physiologic changes and 10 (35.7%) of them needed unplanned ICU admission. Ten patients (35.7%) needed prolonged ventilator support and two (7.14%) of them died. CONCLUSION: The contributing factors that might lead to the incidents were improper decision (75%), lack of experience (53.5%) and lack of knowledge (21.4%). Factors minimizing incident, were vigilance (85.7%), having experienced assistant (50%) and experience in that situation (25%). Suggested preventive strategies were guidelines practice in anesthetic management (67.8%), improvement of supervision (57.1%), additional training (42.8%) and quality assurance activity (28.6%).

Multicentered study of model of anesthesia related adverse events in Thailand by incident report (The Thai Anesthesia Incidents Monitoring Study): results.

OBJECTIVE: The Thai Anesthesia Incidents Monitoring Study (Thai AIMS) was aimed to identify and analyze anesthesia incidents in order to find out the frequency distribution, clinical courses, management of incidents, and investigation of model appropriate for possible corrective strategies. MATERIAL AND METHOD: Fifty-one hospitals (comprising of university, military, regional, general, and district hospitals across Thailand) participated in the present study. Each hospital was invited to report, on an anonymous and voluntary basis, any unintended anesthesia incident during six months (January to June 2007). A standardized incident report form was developed in order to fill in what, where, when, how, and why it happened in both the close-end and open-end questionnaire. Each incident report was reviewed by three reviewers. Any disagreement was discussed and judged to achieve a consensus. RESULTS: Among 1996 incident reports and 2537 incidents, there were more male (55%) than female (45%) patients with ASA PS 1, 2, 3, 4, and 5 = 22%, 36%, 24%, 11%, and 7%, respectively. Surgical specialties that posed high risk of incidents were neurosurgical, otorhino-laryngological, urological, and cardiac surgery. Common places where incidents occurred were operating room (61%), ward (10%), and recovery room (9%). Common occurred incidents were arrhythmia needing treatment (25%), desaturation (24%), death within 24 hr (20%), cardiac arrest (14%), reintubation (10%), difficult intubation (8%), esophageal intubation (5%), equipment failure (5%), and drug error (4%) etc. Monitors that first detected incidents were EKG (46%), Pulse oximeter (34%), noninvasive blood pressure (12%), capnometry (4%), and mean arterial pressure (1%). CONCLUSION: Common factors related to incidents were inexperience, lack of vigilance, inadequate preanesthetic evaluation, inappropriate decision, emergency condition, haste, inadequate supervision, and ineffective communication. Suggested corrective strategies were quality assurance activity, clinical practice guideline, improvement of supervision, additional training, improvement of communication, and an increase in personnel.

The Thai Anesthesia Incident Monitoring Study (Thai AIMS) of post anesthetic reintubation: an analysis of 184 incident reports.

OBJECTIVE: The present study was a part of the Multi-centered Study of Model of Anesthesia related Adverse Events in Thailand by Incident Report (The Thai Anesthesia Incident Monitoring Study or Thai AIMS). The objective of the present study was to determine the outcomes, contributory factors and factor minimizing incident. MATERIAL AND METHOD: The present study was a descriptive research design. The authors extracted relevant data from the incident reports on reintubation after planned extubation after general anesthesia with endotracheal intubation from the Thai AIMS database during the study period January to June 2007. The cases were extensively reviewed by 3 reviewers for conclusion of anesthesia directly and indirectly related reintubation. Comparative analysis between two groups was done. RESULTS: A total 184 incidents of extubation failure according to the definition were extracted in which 129 cases (70.1%) were classified as directly related to anesthesia and 55 cases (29.9%) were indirectly related to anesthesia. Oxygen desaturation occurred in 85.9% of cases while 90.2% of patients was reintubated within 2 hours after extubation. Hypoventilation (58.1%) was the commonest cause which led to reintubation directly related to anesthesia while upper airway obstruction (39.6%) was the commonest cause in the indirectly related anesthesia group. The proportion of preventable incident was 99.2% and 54.5% in directly and indirectly related anesthesia groups, respectively. Human factors particularly including lack of experience and inappropriate decision-making were considered in 99.2%, are directly related to anesthesia reintubation group. CONCLUSION: Extubation failure and reintubation was mostly related to anesthesia. Most of directly related to anesthesia group were considered as preventable. Human factors were also claimed as contributing factors. Quality assurance activity and improvement of supervision to improve experience and competency of decision making were suggested corrective strategies.

Multicentered study of model of anesthesia related adverse events in Thailand by incident report (the Thai Anesthesia Incident Monitoring Study): methodology.

OBJECTIVE: Determine the appropriate model for incident study of adverse or undesirable events in more extensive levels from primary to tertiary hospitals across Thailand. MATERIAL AND METHOD: The present study was mainly a qualitative research design. Participating anesthesia providers are asked to report, on anonymous and voluntary basis, by completing the standardized incident report form as soon as they find a predetermined adverse or undesirable event during anesthesia, and until 24 hours after the operation. Data from the incident report will be reviewed by three peer reviewers and analyzed to identify contributing factors by consensus. CONCLUSION: The THAI anesthesia incidents monitoring study can be used as a model for the development of a local system to provide review and feedback information. This should help generate real improvement in the patient care.