CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2018; 05(02): 87-93
DOI: 10.1055/s-0038-1666884
Original Article
Indian Society of Neuroanaesthesiology and Critical Care

Cardiac Arrest and Death in Neurosurgery: An Analysis of Perioperative Anesthetic Adverse Events in Thailand

Phuping Akavipat
1   Department of Anesthesiology, Prasat Neurological Institute, Bangkok, Thailand
Pimwan Sookplung
1   Department of Anesthesiology, Prasat Neurological Institute, Bangkok, Thailand
Thanatporn Boonsombat
1   Department of Anesthesiology, Prasat Neurological Institute, Bangkok, Thailand
Manee Raksakietisak
2   Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Cataleya Tongrong
3   Department of Anesthesiology, Srinakarind Hospital, Khon Kaen University, Khon Kaen, Thailand
Surunchana Lerdsirisopon
4   Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
Varinee Lekprasert
5   Department of Anesthesiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Yodying Punjasawasdwong
6   Department of Anesthesiology, Maharaj Nakorn Chiangmai Hospital, Chiangmai University, Chiangmai, Thailand
Vichai Ittichaikulton
5   Department of Anesthesiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
› Author Affiliations
Funding Support Royal College of Anesthesiologists of Thailand, Prasat Neurological Institute, Faculty of Medicine of Chiang Mai University, Chulalongkorn University, Khon Kaen University, Mahidol University (Siriraj Hospital and Ramathibodi Hospital), Prince of Songkla University, Health System Research Institute, and National Research Council of Thailand.
Further Information

Publication History

Received: 30 April 2018

Accepted: 24 May 2018

Publication Date:
26 June 2018 (online)


Background Complexities of pathological causes in cardiac arrest and death in neurosurgery require individualized management. To decrease the incidents, this study was performed to describe characteristics and factors reducing adverse outcomes together with potential corrective strategies of perioperative cardiac arrest and death in neurosurgical patients.

Methods An observational study was performed in 22 hospitals. Peer-reviewed consensus was formed using database from Perioperative Anesthetic Adverse Events in Thailand (PAAd Thai) study. The data contain demography, anesthetic, surgical details, opinions on contributing factors, and factors that minimized incident as well as suggested corrective strategies.

Results From 2,000 incidents, 64 (3%) cardiac arrest events were reported with a 50% chance of return of spontaneous circulation. The most common cardiac rhythm documented was asystole. Essentially, electrocardiography was the most frequent early detector. Surgical-related factors (81.3%), mostly intraoperative bleeding, played a major role in potential causes of arrest. In addition, anesthesia, patient conditions, and system-related factors were found in 65.6%, 57.8%, and 8.3% of the incidents, respectively. Moreover, the severity of the patients (73.3%) was considered to be the most common anesthesia-related risk factor. The prevention of an incident included rule enforcement for patient safety, mandatory knowledge, and also anesthesia personnel's skills development.

Conclusion The optimum fluid assessment and resuscitation, cerebral protection protocols, clinical awareness, and quality assurance together with human resource management are all essential to eliminate the catastrophic cardiac arrest and death in neurosurgery.

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