Perioperative and Anesthetic Adverse Events in Thailand (PAAd THAI) Incident Reporting Study: Perioperative Oxygen Desaturation

• Published in: Journal of anesthesia and perioperative medicine 2018-05, Vol.5 (3), p.101-113
• Main Authors: Pin-on, Pathomporn, Panjasawatwong, Krit, Vimuktanandana, Anantachote, Sriraj, Wimonrat, Somchat, Chuthamat, Sriramatr, Dujduen
• Format: Article
• Language: English
• Subjects: Airway management; Anesthesia; Child restraints; Hospitals; Hypoxemia; Hypoxia; Medical personnel; Patient safety; Peer review; Postoperative period; Surgery; Systematic review
• ISSN: 2306-773X; 2520-3002
• DOI: 10.24015/JAPM.2018.0051

Background: The occurrence of hypoxemia in patients undergoing anesthesia is extremely varied. The objective of this study was to report the incidence, explore the causes, and report the outcomes of oxygen desaturation in a large surgical population. Methods: We performed a retrospective study using electronically extracted anesthetic records obtained from 22 academic medical centers across Thailand. All surgical patients under anesthesia during a one-year period were included in the analysis. Hypoxemia was defined as oxygen saturation < 90% for 3 minutes. Any episode of oxygen saturation ≤ 85% was defined as severe hypoxemia. The contributory factors, the factors minimizing incidence and suggested corrective strategies were examined. Results: There were 2,000 incident cases from all centers. Four hundred sixteen of these patients developed oxygen desaturation. The incidence of oxygen desaturation among all incident cases was 0.2. 50.2% of these patients experienced the episode of severe hypoxia. Oxygen desaturation occurred during the intubation period 26.7%. Upper airway obstruction was the leading cause of oxygen desaturation in the induction, intubation, and recovery periods. Circulatory failure concomitant with oxygen desaturation was found mainly during the maintenance period and at the ward. Haste, lack of knowledge, and inadequate patient preparation were considered as major contributory factors. Improved communication skill and more manpower were the most frequently suggested corrective strategies. Conclusion: Hypoxemia is common during the perioperative period despite the widespread availability of oxygen saturation monitors. This study highlighted strategies that will help to reduce the clinical impact of oxygen desaturation. These strategies are improving communication skill and providing adequate manpower. (Funded by the Faculty of Medicine, Chiang Mai University.)