Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study: An Analysis of Suspected Myocardial Ischemia/Infarction

Background: Perioperative myocardial ischemia or infarction (PMI) is infrequent but is a life-threatening complication. The pathophysiology is complex, and the diagnosis can be difficult due to asymptomatic presentations. Objective: To investigate the patient, anesthetic, and surgical characteristics of the suspected PMI incidents, as well as the outcomes, and suggested corrective strategies to avoid the adverse events. Materials and Methods: The suspected PMI incident reports were extracted from the database of the Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) study, conducted between January 1, and December 31, 2015. Surgical patients undergoing anesthesia with suspected PMI reported in 22 hospitals were included. Three anesthesiologists independently reviewed the reports. The patient, anesthetic, and surgical profiles, and other incident details were collected from the standardized report forms. Descriptive statistics were used. Results: Suspected PMI was reported in 29 non-cardiac surgical patients with the mortality rate of 20.7% (6/29 patients). PMI was confirmed in 24 patients (82.8%). Non-ST-elevation MI (NSTEMI) was the predominant diagnosis of all reports (15/29 patients, 51.7%). Most incidents occurred in the operating room and were asymptomatic at presentation. Patient factor was considered the most common predisposing factor (96.5%), followed by surgery (58.6%), and anesthesia (37.9%). Quality assurance activity was the most recommended corrective strategies. Conclusion: PMI is not common among non-cardiac surgical patients in Thailand but causes significant mortality. Understanding the pathophysiology and being aware of PMI are important for appropriate perioperative management. Furthermore, early detection, along with multidisciplinary assessment for optimization of the treatment are crucial for prognostic outcomes. Keywords: Perioperative, Adverse event, Anesthesia, Myocardial, Infarction, Ischemia, Complication

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Suspected Pulmonary Embolism in the First 2,000 Incidents Reports of Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.09.11509 ◽

2020 ◽

Vol 103 (9) ◽

pp. 869-877

Keyword(s):

Pulmonary Embolism ◽

Adverse Events ◽

Clinical Presentation ◽

Patient Characteristics ◽

Thromboembolic Complication ◽

Adverse Outcomes ◽

Risk Patients ◽

Life Threatening ◽

Incident Reports ◽

Orthopedic Patients

Background: Perioperative pulmonary embolism (PE) is a rare but life-threatening complication. The diagnosis remains challenging due to non-specific clinical presentations, which may vary from asymptomatic to cardiovascular collapse. Objective: To describe the clinical presentation, diagnosis, and outcomes of the patients after suspected PE as well as to investigate the cause among Thai surgical population. Materials and Methods: The authors conducted an observational study by retrospective analysis of the data from the Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) study. All surgical patients under anesthesia in 22 participating hospitals between January 1 and December 31, 2015, were included. The incident reports of suspected PE were reviewed independently by three anesthesiologists. Data regarding patient characteristics, clinical manifestation, and other details were obtained from the standardized incident report forms. Descriptive statistics was used. Results: Of the 2,000 incident reports, 16 patients were diagnosed with suspected PE. Cardiac arrest occurred in 11 cases (68.7%) and the overall mortality rate was 37.5% (6 of 16 patients). Most incidents were reported in orthopedic patients (10 cases, 62.5%) and caused by thrombosis (13 cases, 81.2%). Most of the incidents occurred intraoperatively (10 cases, 62.5%). The confirmatory imaging studies were investigated in eight cases (50%). To minimize the adverse outcomes, having more experience along with the help from experienced assistants and improved multidisciplinary support, were predominantly recommended. In addition, the most frequent suggested corrective strategies were implementation of appropriate clinical practice guideline and quality assurance activity. Conclusion: Perioperative PE causes significant morbidity and mortality. The diagnosis remains difficult but early detection of suspicious clinical presentation and optimization of the treatment are crucial. Identification of high-risk patients, intraoperative vigilance, and effective interdepartmental communication should be considered to improve patient outcomes. Keywords: Perioperative, adverse event, anesthesia, pulmonary embolism, thromboembolic, complication

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Adverse Events in Colorectal Surgical Patients Remaining in Hospital whilst Awaiting Medical Review, Rehabilitation or Long-Term Placement

Endoscopy ◽

10.1055/s-2006-956901 ◽

2006 ◽

Vol 38 (11) ◽

Author(s):

T Kallachil ◽

K Sevar ◽

C Benzoni ◽

T Daniel

Keyword(s):

Adverse Events ◽

Surgical Patients ◽

Medical Review

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Adverse Events Reporting System as Experienced by Critical-Care Nurses in KwaZulu-Natal, South Africa

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/2456 ◽

2018 ◽

Vol 20 (1) ◽

Author(s):

Thusile Mabel Gqaleni ◽

Busisiwe Rosemary Bhengu

Keyword(s):

South Africa ◽

Critical Care ◽

Adverse Events ◽

Patient Care ◽

Family Involvement ◽

Reporting System ◽

Legal Framework ◽

Critical Care Nurses ◽

Kwazulu Natal ◽

Life Threatening

Critically ill patients admitted to critical-care units (CCUs) might have life-threatening or potentially life-threatening problems. Adverse events (AEs) occur frequently in CCUs, resulting in compromised quality of patient care. This study explores the experiences of critical-care nurses (CCNs) in relation to how the reported AEs were analysed and handled in CCUs. The study was conducted in the CCUs of five purposively selected hospitals in KwaZulu-Natal, South Africa. A descriptive qualitative design was used to obtain data through in-depth interviews from a purposive sample of five unit managers working in the CCUs to provide a deeper meaning of their experiences. This study was a part of a bigger study using a mixed-methods approach. The recorded qualitative data were analysed using Tesch’s content analysis. The main categories of information that emerged during the data analysis were (i) the existence of an AE reporting system, (ii) the occurrence of AEs, (iii) the promotion of and barriers to AE reporting, and (iv) the handling of AEs. The findings demonstrated that there were major gaps that affected the maximum utilisation of the reporting system. In addition, even though the system existed in other institutions, it was not utilised at all, hence affecting quality patient care. The following are recommended: (1) a non-punitive and non-confrontational system should be promoted, and (2) an organisational culture should be encouraged where support structures are formed within institutions, which consist of a legal framework, patient and family involvement, effective AE feedback, and education and training of staff.

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Proton Pump Inhibitors in 2021: Pros, Cons, and Everything in Between

Foregut: The Journal of the American Foregut Society ◽

10.1177/26345161211021766 ◽

2021 ◽

pp. 263451612110217

Author(s):

Joshua A. Sloan ◽

Philip O. Katz

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Adverse Events ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Drug Class ◽

Life Threatening

The medical and lay literature has exploded with reports of adverse events associated with proton pump inhibitors over the last 10 to 15 years. The dissemination of these reports to patients and clinicians have created substantial concerns regarding what has been an exceptionally valuable drug class, dramatically improving patient quality of life, and in many cases preventing life threatening side effects of other medication. Patients are more frequently seeking to avoid these medications, and practitioners are reducing or discontinuing them to the patient’s detriment due to a misunderstanding of the data. This review will discuss the data regarding the most commonly publicized adverse events and attempt to put them in perspective.

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Management of ST Elevation Myocardial Infarction (STEMI) in Different Settings

International Journal of Angiology ◽

10.1055/s-0041-1723944 ◽

2021 ◽

Author(s):

Rod Partow-Navid ◽

Narut Prasitlumkum ◽

Ashish Mukherjee ◽

Padmini Varadarajan ◽

Ramdas G. Pai

Keyword(s):

Myocardial Infarction ◽

Treatment Strategies ◽

Management Process ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Multiple Factors ◽

St Segment ◽

Threatening Condition ◽

Life Threatening ◽

St Elevation

AbstractST-segment elevation myocardial infarction (STEMI) is a life-threatening condition that requires emergent, complex, well-coordinated treatment. Although the primary goal of treatment is simple to describe—reperfusion as quickly as possible—the management process is complicated and is affected by multiple factors including location, patient, and practitioner characteristics. Hence, this narrative review will discuss the recommended management and treatment strategies of STEMI in the circumstances.

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Short-term risk stratification using CADILLAC risk score in patients with ST elevation myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1352 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Satou ◽

H Kitahara ◽

K Ishikawa ◽

T Nakayama ◽

Y Fujimoto ◽

...

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Adverse Events ◽

Risk Score ◽

Risk Group ◽

Risk Groups ◽

Low Risk ◽

Short Term ◽

Recurrent Myocardial Infarction ◽

St Elevation

Abstract Background The recent reperfusion therapy for ST-elevation myocardial infarction (STEMI) has made the length of hospital stay shorter without adverse events. CADILLAC risk score is reportedly one of the risk scores predicting the long-term prognosis in STEMI patients. Purpose To invenstigate the usefulness of CADILLAC risk score for predicting short-term outcomes in STEMI patients. Methods Consecutive patients admitted to our university hospital and our medical center with STEMI (excluding shock, arrest case) who underwent primary PCI between January 2012 and April 2018 (n=387) were enrolled in this study. The patients were classified into 3 groups according to the CADILLAC risk score: low risk (n=176), intermediate risk (n=87), and high risk (n=124). Data on adverse events within 30 days after hospitalization, including in-hospital death, sustained ventricular arrhythmia, recurrent myocardial infarction, heart failure requiring intravenous treatment, stroke, or clinical hemorrhage, were collected. Results In the low risk group, adverse events within 30 days were significantly less observed, compared to the intermediate and high risk groups (n=13, 7.4% vs. n=13, 14.9% vs. n=58, 46.8%, p<0.001). In particular, all adverse events occurred within 3 days in the low risk group, although adverse events, such as heart failure (n=4), recurrent myocardial infarction (n=1), stroke (n=1), and gastrointestinal bleeding (n=1), were substantially observed after day 4 of hospitalization in the intermediate and high risk groups. Conclusions In STEMI patients with low CADILLAC risk score, better short-term prognosis was observed compared to the intermediate and high risk groups, and all adverse events occurred within 3 days of hospitalization, suggesting that discharge at day 4 might be safe in this study population. CADILLAC risk score may help stratify patient risk for short-term prognosis and adjust management of STEMI patients. Initial event occurrence timing Funding Acknowledgement Type of funding source: None

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Efficacy and safety of combined endoscopic cyanoacrylate injection and balloon-occluded retrograde transvenous occlusion (BRTOcc) of gastrorenal shunts in patients with bleeding gastric fundal varices

Gastroenterology Report ◽

10.1093/gastro/goaa082 ◽

2020 ◽

Author(s):

Fateh Bazerbachi ◽

Akira Dobashi ◽

Swarup Kumar ◽

Sanjay Misra ◽

Navtej S Buttar ◽

...

Keyword(s):

Adverse Events ◽

Gastric Varices ◽

High Rate ◽

Efficacy And Safety ◽

Cyanoacrylate Glue ◽

Serious Adverse Events ◽

Gastroesophageal Varices ◽

Life Threatening ◽

Glue Embolization

Abstract Background Endoscopic cyanoacrylate (glue) injection of fundal varices may result in life-threatening embolic adverse events through spontaneous gastrorenal shunts (GRSs). Balloon-occluded retrograde transvenous occlusion (BRTOcc) of GRSs during cyanoacrylate injection may prevent serious systemic glue embolization through the shunt. This study aimed to evaluate the efficacy and safety of a combined endoscopic–interventional radiologic (BRTOcc) approach for the treatment of bleeding fundal varices. Methods We retrospectively analysed the data of patients who underwent the combined procedure for acutely bleeding fundal varices between January 2010 and April 2018. Data were extracted for patient demographics, clinical and endoscopic findings, technical details, and adverse events of the endoscopic–BRTOcc approach and patient outcomes. Results We identified 30 patients (13 [43.3%] women; median age 58 [range, 25–92] years) with gastroesophageal varices type 2 (53.3%, 16/30) and isolated gastric varices type 1 (46.7%, 14/30) per Sarin classification, and median clinical and endoscopic follow-up of 151 (range, 4–2,513) days and 98 (range, 3–2,373) days, respectively. The median volume of octyl-cyanoacrylate: Lipiodol injected was 7 (range, 4–22) mL. Procedure-related adverse events occurred in three (10.0%) patients, including transient fever, non-life-threatening pulmonary glue embolism, and an injection-site ulcer bleed. Complete gastric variceal obturation was achieved in 18 of 21 patients (85.7%) at endoscopic follow-up. Delayed variceal rebleeding was confirmed in one patient (3.3%) and suspected in two patients (6.7%). Although no procedure-related deaths occurred, the overall mortality rate was 46.7%, primarily from liver-disease progression and co-morbidities. Conclusion The combined endoscopic–BRTOcc procedure is a relatively safe and effective technique for bleeding fundal varices, with a high rate of variceal obturation and a low rate of serious adverse events.

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