Perioperative and anesthetic adverse events in Thailand (PAAd Thai) study database: Neuroanesthesia

Abstract

© 2020 Journal of The Medical Association of Thailand. Background: The incident report in neurosurgical anesthesia was part of the Perioperative and Anesthetic Adverse Events in Thailand Study (PAAd Thai) of the Royal College of Anesthesiologists of Thailand in 2015. There were scarce reports of perioperative anesthetic adverse events in neurosurgical cases. Objective: To investigate anesthetic complications and causes, and contributing factors including corrective strategies for the prevention of adverse events in neurosurgical cases. Materials and Methods: A prospective descriptive study was conducted in 22 hospitals across Thailand. Perianesthetic adverse incidents were reported by a standardized incident report form during 12 months period (between January and December 2015). Adverse events of neurosurgical cases were reviewed to demonstrate the causes. Descriptive statistics were used. Results: Among the first 2,000 incident reports from the PAAd Thai study, 228 critical incidents from the 157 incident report forms of neurosurgical cases were reported. The incidents commonly occurred in male patients (56.0%). The major age range was 40 to 70 years. The common adverse events included cardiac arrest within 24 hours (36.3%), death (33.1%), reintubation (15.3%), desaturation (10.8%), severe arrhythmia (10.2%), and difficult intubation (6.4%). Anesthesia was considered as part of the contributing factors in 70 reports while it was considered as the sole factor in 26 reports. Conclusion: Cardiac arrests, death, and reintubation were common incidents in neurosurgical anesthesia. Common factors contributing to the incidents were inexperience, severe increased intracranial pressure, inadequate preanesthetic evaluation, emergency condition, inappropriate decision, and communication. Factors minimizing the incidents were vigilance, having experience, experienced assistant, improvement of training, comply to practice guidelines, and effective communication. Suggested corrective strategies were quality assurance activity, improvement of supervision, additional training, improvement of communication, compliance with guidelines, and more equipment.