Failed intubation in the perioperative and anesthetic adverse events in Thailand (PAAD thai) study: Perspectives of technical skills and anesthetists’ non-technical skills (ANTS)

Abstract

© 2018, Medical Association of Thailand. All rights reserved. Objective: The Royal College of Anesthesiologists of Thailand (RCAT) has performed the study called “The Perioperative Anesthetic Adverse Events Study in Thailand (PAAd Thai)”. It was a multi-center, prospective, observational trial conducted in 22 hospitals throughout Thailand in 2015. This study is a part of the PAAd Thai which specifically aimed to focus on failed intubation with the view of technical skills and Anesthetists’ Non-Technical Skills (ANTS). Materials and Methods: The PAAd Thai working group created a standardized incident record form. Each incident including failed intubation was reported directly to a center of data management using this form. Two anesthesiologists (SN, PP) separately used the ANTS behavioral rating tool (4 categories, 15 elements) to assess performances of the healthcare providers involved in each incident report of failed intubation. Results: Among 2,206 incident reports, there were 16 cases (0.7%) of failed intubation. Overall incidence per 10,000 with 95% CI was 0.74 (0.38-1.10). More than half of them were not obese. Difficult intubation was predicted in 56.25% of the cases. McIntosh blade was the most frequently used equipment. Five cases were cancelled while 11 went on for surgery using either a laryngeal mask airway (55%) or tracheostomy (45%). The 2 most common complications were hypoxia (43.75%) and esophageal intubation (12.50%). No cardiac arrest happened. With ANTS, there was 0 case which the 2 authors had the same ratings for all elements. Moreover, none of the elements were marked with the same ratings by the 2 authors. Identifying options as well as balancing risks and selecting options (decision making) were rated in concordance for 12 incident reports. Conversely, prioritizing (task management) as well as using authority and assertiveness (team working) accounted for 0 agreement. Conclusion: The incidence of failed intubation was low and no case experienced very serious complications. Using the ANTS scoring system to evaluate performances of anesthetic practitioners from the incident reports showed various agreements between the 2 authors.