Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study: An Analysis of Suspected Myocardial Ischemia/Infarction
Athitarn Earsakul MD¹, Anantachote Vimuktanandana MD¹, Sasikaan Nimmaanrat MD², Worawut Lapisatepun MD³, Thidarat Ariyanuchitkul MD⁴, Phongpat Sattayopas MD⁵
Affiliation : ¹ Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ² Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand ³ Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ⁴ Department of Anesthesiology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand ⁵ Department of Anesthesiology, Nakornping Hospital, Chiang Mai, Thailand
Background : Perioperative myocardial ischemia or infarction (PMI) is infrequent but is a life-threatening complication. The pathophysiology is
complex, and the diagnosis can be difficult due to asymptomatic presentations.
Objective : To investigate the patient, anesthetic, and surgical characteristics of the suspected PMI incidents, as well as the outcomes, and suggested corrective strategies to avoid the adverse events.
Materials and Methods : The suspected PMI incident reports were extracted from the database of the Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) study, conducted between January 1, and December 31, 2015. Surgical patients undergoing anesthesia with suspected PMI reported in 22 hospitals were included. Three anesthesiologists independently reviewed the reports. The patient, anesthetic, and surgical profiles, and other incident details were collected from the standardized report forms. Descriptive statistics were used.
Results : Suspected PMI was reported in 29 non-cardiac surgical patients with the mortality rate of 20.7% (6/29 patients). PMI was confirmed in 24 patients (82.8%). Non-ST-elevation MI (NSTEMI) was the predominant diagnosis of all reports (15/29 patients, 51.7%). Most incidents occurred in the operating room and were asymptomatic at presentation. Patient factor was considered the most common predisposing factor (96.5%), followed by surgery (58.6%), and anesthesia (37.9%). Quality assurance activity was the most recommended corrective strategies.
Conclusion : PMI is not common among non-cardiac surgical patients in Thailand but causes significant mortality. Understanding the pathophysiology and being aware of PMI are important for appropriate perioperative management. Furthermore, early detection, along with multidisciplinary assessment for optimization of the treatment are crucial for prognostic outcomes.
Received 17 August 2020 | Revised 26 August 2020 | Accepted 1 September 2020
doi.org/10.35755/jmedassocthai.2021.01.11785
Keywords : Perioperative, Adverse event, Anesthesia, Myocardial, Infarction, Ischemia, Complication
