Background: Esophageal intubation [EI] is one of the most common events in perioperative airway management especially in anesthesia training situations.

Objective: To examine incidents and contributing factors including corrective strategies of EI in the Perioperative and Anesthetic Adverse Events in Thailand [PAAd Thai] Study, hosted by the Royal College of Anesthesiologists of Thailand.

Materials and Methods: A multi-center prospective observational study was conducted between January and December 2015. All EI incidents from the first 2,000 incident reports from 22 participating hospitals across Thailand were reported and analyzed using descriptive statistics.

Results: One hundred sixty-nine EI incidents (8.45%) were reported from the first 2,000 incident reports in the PAAd Thai database. The incidence of delayed detection of EI was rare (0.28:10,000). Practice with trainees is a common situation (55.6%), however, most cases were early detection by clinical examination and/or capnometer without physiologic sequelae. Pediatric patients, cesarean section, and difficult intubation may lead to oxygen desaturation, with few cases of oxygen desaturation and bradycardia.

Conclusion: While the EI incidence rates in Thailand remained constant, the incidence of delayed detection was dramatically reduced because of increased availability of end-tidal carbon dioxide monitoring. Vigilance, additional training, and more equipment availability are recommended.

Keywords: Esophageal intubation, Incident report, Outcome, Monitoring, Adverse events, Complication