J Med Assoc Thai 2010; 93 (11):1274

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Anesthesia-Related Complications of Caesarean Delivery in Thailand: 16,697 Cases from the Thai Anaesthesia Incidents Study
Chau-in W Mail, Hintong T , Rodanant O , Lekprasert V , Punjasawadwong Y , Charuluxananan S , Tanudsintum S

Background: Maternal complications related to anesthesia are low in comparison with the results from
obstetric factors in developing countries. The purposes of the present study were to determine the incidence of
maternal mortality related to anesthesia, to analyze the causes and to suggest measures to improve anesthetic
safety for the parturients.

Material and Method: The present study was part of a multi-center study conducted by the Royal College of
Anesthesiologists of Thailand aimed at surveillance of anesthesia-related complications in Thailand. The
authors conducted a prospective survey of hospital records from all of the cases in and outside the operating
room receiving general anesthesia in 18 centers between March 1, 2003 and February 28, 2004. All the forms
were checked and verified by three-peer review then included in the analysis, using descriptive statistics.

Sixteen thousand six hundred ninety seven cases were included. The incidence of anesthetic
complication in parturients was 35.9:10,000 (95% CI 27.4, 46.1). Incidence of the four most common anesthetic
related adverse events in caesarean section were desaturation 13.8 (95% CI 8.7, 20.7), cardiac arrest 10.2
(95% CI 5.9, 16.3), awareness 6.6 (95% CI 3.3, 11.8), and death related anesthesia 4.8 (95% CI 2.17, 9.4). Of
these, seven (17.5%) had preeclampsia/eclampsia and 46 (76.7%) presented for emergency caesarean delivery.
General anesthesia was used in 41 patients (68.4%) and spinal in eighteen (30%). There were eight maternal
deaths including five with general anesthesia, giving a case fatality rate of 0.1% of general anesthetics or
0.3% of caesarean deliveries.

Conclusion: The authors found that inexperience, inadequate knowledge, inadequate care, and patient
conditions were the major contributory factors. Most of them were preventable and correctable. Additional
training and quality assurance can improve and prevent these serious adverse events.

Keywords: Anesthesia, Complications, Caesarean delivery, Cause, Incidence

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