 Incident reports from anesthesia in morbid obesity according to PAAd Thai study

Oraluxna Rodanant, M.D.* Waraporn Chau-in, M.D.** Somrat Charuluxananan, M.D.*Santhiti Morakul, M.D.***
 Sukanya Pongruekdee, M.D.#, Umpawan Tanyong, M.D.##
* Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University
** Department of Anesthesiology, Faculty of Medicine, Kornkan University
*** Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital. Mahidol University
# Charoenkrung Pracharak Hospital, ### Chonburi Hospital

Abstract
Background: In 2015, January 1st to December 31st, the Royal College of Anesthesiologists of Thailand (RCAT) contributed the multicenter study, the Perioperative and Anesthetic Adverse Events in Thailand study (PAAd Thai) in 22 hospitals across Thailand.
Objective: This study aimed to determine the frequency of incidents related to anesthetic complications, contributing factors and corrective strategies in patients whose BMI were equal or over 35 kg/m2. 
Methods: This study was part of multicenter and prospective study. After being approved by every institutional ethical committee, written informed consent were waived, each hospital was asked to anonymously report incidence of anesthesia related adverse events which occurred during 24 hours. Patient were selected from the BMI equal or over 35 kg/m2. undergoing surgeries. These incident reports. were discussed and analyzed by three reviewers for contributing factors, clinical courses, factors minimizing incident and suggested corrective strategies.
Results: There were 58 cases (2.63%) from a total 2,206 reports of PAAD Thai study. Seventy eight incidents occurred from 3,028 critical incidents reports (2.57%). 36.21% were male and 63.79% were female. The average age was 39.96 year and BMI was 39.8 + 5.09 kg/m2. The highest incidence occurred in patients with BMI 35-39.9 kg/m2 (65.52%). 53.45% were classified as ASA physical status 3. The adverse events were found more frequent in elective surgery (40 incidents or 68.96%) than emergency surgery. General surgery with explore laparotomy had the higher incidents compared to other surgical specialties. Oxygen desaturation was the most common incident. Severe arrhythmia, difficult intubation and cardiac arrest in 24 hour postoperatively were found in the same frequency. Overall contributing factors from this report were inadequate preanesthetic evaluation and preparation, haste, inexperience and inappropriate decision. Having experiences, more vigilance and have experienced assistant or effective supervision might be the factor for minimizing outcomes. 
Conclusion: Increasing the obesity and morbid obesity population in our society require much more concern not only the physiological changes but also the diseases that come along with. The majority of adverse events is respiratory event which is oxygen desaturation. Contributing factors in most complications found associated with haste and inadequate patient preparations which could be preventable. For anesthesiologists, perioperative management of obese patients should have high vigilance and need more skills. Specific scoring systems for evaluate risks prior to each procedure must be considered. Improving personal competency care in post anesthesia care unit (PACU) may help reduce the reintubation events by increasing personal and revised protocol used in PACU.  The standard practice guidelines, improve supervision, additional training and also frequently organize the quality assurance activity can minimized the adverse events and help improve quality and patient safety undergoing anesthesia in obese patient.




04 / Incident reports from anesthesia in morbid obesity according to PAAd Thai Study.