Prospective analysis of intraoperative critical incidents relevant to anaesthesia in a tertiary care teaching hospital in India

Abstract

Background and Aims: Critical incidents associated with anesthesia can affect the patient's outcome, may cause transient damage, and contribute to mortality. We aimed at recording anesthesia-related critical incidents in patients undergoing general surgical, ear, nose, and throat (ENT) and orthopedic surgical procedures in our institution. The critical incidents data were analyzed regarding the cause to establish protocols to prevent recurrences. Material and Methods: We conducted a prospective analysis of voluntarily reported perioperative critical incidents occurring in patients subjected to anesthesia over 1 year. Critical incidents were noted in terms of time (while inducing/intraoperative/while extubating), location (operating theater/recovery room) of the incident, anesthesia-related or surgery-related complications. Data collected were expressed as numbers and proportions to calculate incidence. Results: Anesthesia was administered to 5,645 patients of which 131 (2.32%) patients had critical incidents. Of these 131, 46 (35.11%) patients had more than one critical incident. A total of 216 (3.82%) critical incidents were noted. A majority of the patients were in the age range of 51-60 years. The maximum incidents occurred during the intraoperative period (35.11%) and in the operating theater (86.25%). Of the 216 incidents, 154 (71.30%) were anesthesia-related, 18 (8.33%) were surgery-related, 1 (0.46%) was patient-related and 43 (19.91%) were recovery-related. Of the 216 incidents, cardiovascular-related incidents accounted for the maximum incidents (18.05%, n = 39). Most of the events were preventable. Conclusion: The critical incident reporting system should be encouraged and protocols established to reduce the frequency and severity of these occurrences.