Abstract
Background & Objectives: Even though the medical technology, anesthetic techniques, pharmacological agents and monitoring system have been ameliorated but the incidence of intraoperative awareness has still been identified (0.005-0.038%). The information about this problem on the possible protective scheme, pitfalls and management modality might differ from the last decade according to the Thai Anesthesia Incidents Study (THAI study) and Thai Anesthesia Incident Monitoring Study (THAI AIMS). Therefore, this large multicenter study supported by the Royal College of Anesthesiologists of Thailand was performed and aimed to describe the awareness incidents including the relevant across Thailand during January-December, 2015. Materials & Methods: The observational prospective study was conducted within 21 hospitals throughout Thailand. The awareness category was selected from the incident report according to Perioperative Anesthetic Adverse Events in Thailand (PAAD THAI) study database. The characteristics of awareness and the factors related were declared. Moreover, crucial sections of factors contributing to the incident, factors minimizing the situation, suggested correcting strategies, and pertinent treatment were investigated, reviewed and made a consensus by three peer reviewers. The descriptive statistics was analyzed. Results: There were 9 episodes from 2,000 incidences totally. The average age was 44.5±19.1 years with American Society of Anesthesiologists (ASA) physical status class II mainly. Eight of them received general anesthesia balanced technique with inhalation agent and one obtained total intravenous anesthesia. Fifty-five percent were monitored with endtidal gas analyzer and adjusted depth of anesthesia by an anesthesiologist who had 10.9±11.4 years experienced. Pain perception 8 (8.8%), sounds 7 (77.7%), paralysis 3(33.3%) were found during anesthetic maintenance. The incurring possibilities were anesthesia 8 (100%), patient 5 (55.5%) and system related 2 (22.2%). Although the immediate outcomes showed 2 (25%) for temporary stress and 1 (12.5%) for anxiety, the treatment and management were acceptable. The contributing factors were situational inexperience 7 (77.8%) and inappropriate patient evaluation 4 (44.4%). An awareness of anesthetic performer 9 (100%) and experienced 8 (88.8%) were defined as factors minimizing incident. The suggested corrective strategies were quality assurance activity 8 (88.8%), improved supervision 4 (44.4%) and equipment utilization 3 (33.3%) respectively. Conclusion: The intraoperative awareness incidents were report periodically, however the causes were preventable. Anesthetic component seems to be the most influence to prevent the circumstance and lessen the harmful psychological sequelae.
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