The Thai Anesthesia Incident Monitoring Study (Thai AIMS): An Analysis of Perioperative Myocardial Ischemia/Infarction
Pornswan Ngamprasertwong MD*, Inthiporn Kositanurit MD**, Preechayuth Yokanit MD***, Rhuthai Wattanavinit MD****, Sunida Atichat MD*****, Worawut Lapisatepun MD******
Affiliation : * Department of Anesthesiology, Chulalongkorn University, Bangkok ** Department of Anesthesiology, Naresuan University, Phitsanulok *** Department of Anesthesiology, Phramongkutklao College of Medicine, Bangkok **** Department of Anesthesiology, Udonthanee Regional Hospital, Udonthanee ***** Department of Anesthesiology, Chonburi Regional Hospital, Chonburi ****** Department of Anesthesiology, Chiang Mai University, Chiang Mai
Objective : To analyze the clinical course, outcome, contributing factors and factors minimizing the incidents
of perioperative myocardial ischemia or infarction (PMI) from Thai AIMS study.
Material and Method: The present study was a prospective multicenter study. Data was collected from 51
hospitals in Thailand during a six-month period. The participating anesthesia provider completed the
standardized incident report form of the Thai AIMS as soon as they found the PMI incident. Each incident was
reviewed by three peer reviewers for clinical courses, contributing factors, outcome and minimizing factors of
PMI.
Results : From the Thai AIMS incident report, the authors found 25 suspected PMI cases which was 0.9% of the
2,669 incidents reported in the present study. Most of the PMI occurred in elective cases (84%) and orthopedic
procedures (56%). The majority of PMI was reported from the patients undergoing general anesthesia (72%).
Suspected PMI occurred mostly during operations (56%). New ST-T segment change was detected in 92% of
these patients. The most common immediate outcome of PMI was major physiological change (88%). The most
common management effect of PMI was unplanned ICU admission (64%); the others were prolonged ventilatory
support (12%) and prolonged hospital stay (16%). Four patients (16%) died after the suspected PMI. Most of
the events occurred spontaneously and were unpreventable (80%). Patient factors (100%), anesthesia factors
(72%), surgical factors (32%) and system factors (8%) were all judged as a precipitating factor for PMI.
Human factors were the most common contributing factors which included poor preoperative evaluation,
inexperience and improper decision. The three most common factors minimizing the adverse incidents included
prior experienced, high awareness and experienced assistance. The recommended corrective strategies were
guideline practice, quality assurance activity, improvement of supervision and additional training.
Conclusion : Perioperative myocardial ischemia/infarction was infrequent but may be lethal. Patient factors
were the most common precipitating cause. The morbidity and mortality could be reduced by high quality
preoperative evaluation and preparation, early detection and appropriate treatment. Guideline practice,
quality assurance activity, improvement of supervision and additional training were suggested corrective
strategies.
Keywords : Anesthesia, Adverse events, Multicenter study, Myocardial ischemia, Myocardial infarction, Incident report
