Anesthesia-related complications of caesarean delivery in Thailand: 16,697 cases from the Thai Anaesthesia Incidents Study.
BACKGROUND
Maternal complications related to anesthesia are low in comparison with the results from obstetric factors in developing countries. The purposes of the present study were to determine the incidence of maternal mortality related to anesthesia, to analyze the causes and to suggest measures to improve anesthetic safety for the parturients.


METHODS
The present study was part of a multi-center study conducted by the Royal College of Anesthesiologists of Thailand aimed at surveillance of anesthesia-related complications in Thailand. The authors conducted a prospective survey of hospital records from all of the cases in and outside the operating room receiving general anesthesia in 18 centers between March 1, 2003 and February 28, 2004. All the forms were checked and verified by three-peer review then included in the analysis, using descriptive statistics.


RESULTS
Sixteen thousand six hundred ninety seven cases were included. The incidence of anesthetic complication in parturients was 35.9: 10,000 (95% CI 27.4, 46.1). Incidence ofthe four most common anesthetic related adverse events in caesarean section were desaturation 13.8 (95% CI 8.7, 20.7), cardiac arrest 10.2 (95% CI 5.9, 16.3), awareness 6.6 (95% CI 3.3, 11.8), and death related anesthesia 4.8 (95% CI 2.17, 9.4). Of these, seven (17.5%) had preeclampsia/eclampsia and 46 (76.7%) presented for emergency caesarean delivery. General anesthesia was used in 41 patients (68.4%) and spinal in eighteen (30%). There were eight maternal deaths including five with general anesthesia, giving a case fatality rate of 0.1% of general anesthetics or 0.3% of caesarean deliveries.


CONCLUSIONS
The authors found that inexperience, inadequate knowledge, inadequate care, and patient conditions were the major contributory factors. Most of them were preventable and correctable. Additional training and quality assurance can improve and prevent these serious adverse events.
Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. warcha@kku.ac.th
Waraporn
W
Chau-in
Thanoo
T
Hintong
Oraluxna
O
Rodanant
Varinee
V
Lekprasert
Yodying
Y
Punjasawadwong
Somrat
S
Charuluxananan
Surasak
S
Tanudsintum
D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects* / Q000401:mortality; D000777:Anesthetics / Q000009:adverse effects*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008428:Maternal Mortality; D008499:Medical Records; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D011446:Prospective Studies; D011787:Quality of Health Care; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology
D000777:Anesthetics