Articles: anesthesia.
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Multicenter Study
The Thai Anesthesia Incidents Study (THAI Study) of anesthetic outcomes: II. Anesthetic profiles and adverse events.
The purposes of the Thai Anesthesia Incidents Study (THAI Study) of anesthetic outcomes were to survey patients, surgical, anesthetic profiles and determine factors related to adverse events. ⋯ Respiratory adverse events were common anesthesia direct related events. High incidence of cardiac arrest and death within 24 hr highlighted concerns for prevention strategies. Incidents of adverse events can be used for institutional quality improvement, educational quality assurance and further research for patient safety in anesthesia.
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Multicenter Study
Mapping changes in surgical mortality over 9 years by peer review audit.
There is increasing public scrutiny of deaths among surgical patients. This analysis sought evidence of changes in practice over time in the management of patients who died under surgical care. ⋯ Through continuous peer review audit, the SASM has mapped and may have contributed to changes in surgical and anaesthetic practice over a 9-year period, indicating that the rate of adverse events can be decreased by changing clinician practice (DVT prophylaxis) and provision of facilities (HDU/ITU). Similar approaches should be considered by other medical specialties.
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Multicenter Study
An analysis of intraoperative recall of awareness in Thai Anesthesia Incidents Study (THAI Study).
This study aimed to analyze intraoperative awareness using database of Thai Anesthesia Incidents Study (THAI Study) with regard to frequency, contributing factors, preventive and corrective strategies. ⋯ 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.
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Multicenter Study
Delayed detection of esophageal intubation: Thai Anesthesia Incidents Study (THAI Study) database of 163,403 cases.
Even though esophageal intubation is a common event in anesthesia practice, frequently it is easily detected and resolved. However delayed detection of esophageal intubation (DDEI) can lead to many serious adverse events such as severe hypoxemia, cardiac arrhythmia, cardiac arrest and brain death. ⋯ The overall incidence of DDEI in Thailand was 5.2:10,000. Contributing factors included infant patients, emergency operation, and rapid sequence induction with cricoid pressure. Increased awareness and additional training are suggested as preventive strategies.
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Multicenter Study
The Thai Anesthesia Incidents Study (THAI Study) of anesthetic equipment failure/malfunction: a qualitative analysis for risk factors.
Anesthesia equipment problems may contribute to anesthetic morbidity and mortality. In Thailand, the magnitude and pattern of these problems has not been established. We therefore analyzed the frequency, type and severity of equipment-related problems, and what additional efforts might be needed to improve safety. ⋯ The incidence and severity of equipment problems was low. Aside from improvements to pre-operative equipment checks, vigilance, continuous quality improvement and quality assurance activities were suggested as strategies to reduce problems.