Affiliations: [a] Department of Anesthesiology, Prasat Neurological Institute, Bangkok, Thailand | [b] Department of Anesthesiology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand | [c] Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand | [d] Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand | [e] Faculty of Medicine, Khon Kaen University, Srinagarind Hospital, Khon Kaen, Thailand | [f] Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand | [g] Faculty of Medicine, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand | [h] Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
Correspondence:
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Address for correspondence: Phuping Akavipat, Department of Anesthesiology, Prasat Neurological Institute, 312 Rajvithee road, Bangkok 10400, Thailand. Tel.: +66 81 6144393; Fax: +662 6684400; E-mail: [email protected]
Abstract: BACKGROUND:Despite the improvement of anesthetic-related modalities, the incidence of unintended intraoperative awareness remains at around 0.005–0.038%. OBJECTIVE:We aimed to describe the intraoperative awareness incidents that occurred across Thailand between January to December, 2015. METHODS:Observational data was collected from 22 hospitals throughout Thailand. The awareness category was selected from incident reports according to the Perioperative Anesthetic Adverse Events in Thailand (PAAd Thai) study database and descriptive statistics were analyzed. The awareness characteristics and the related factors were recorded. RESULTS:A total of nine intraoperative awareness episodes from 2000 incidents were observed. The intraoperative awareness results were as follows: experience of pain (38.1%), perception of sound (33.3%), perception of intubation (9.5%) and feeling of paralysis (14.3%). The observed factors that affect intraoperative awareness were anesthesia-related (100%), patient-related (55.5%), surgery-related (22.2%) and systematic process-related (22.2%). The contributing factors were situational inexperience (77.8%) and inappropriate patient evaluation (44.4%). An awareness of anesthetic performer (100%) and experience (88.9%) were defined as incident-mitigating factors. The suggested corrective strategies were quality assurance activity (88.9%), improved supervision (44.4%) and equipment utilization (33.3%), respectively. CONCLUSION:Nine intraoperative awareness incidents were observed, however the causes were preventable. The anesthetic component seems to be the most influential to prevent these events.
Keywords: Complication, risk, unintentional awareness, national audit project, PAAd Thai
