Perioperative non-hypoxic bradycardia in pediatric patients: Thai anesthesia incident monitoring study (Thai AIMS)

Results: There were 49 cases of perioperative non-hypoxic bradycardia in pediatric patients (2.4% of all 1996 incident reports or 13.4% of all incident reports from pediatric patients). Anesthesia (71%) was a major factor that related to the bradycardia, wheareas 19% and 10% were surgical and patient factors, respectively. Sixty percent of cases occurred during induction, of which 80% (24 out of 30 cases) and 10% were considered as anesthesiarelated or combination of anesthesia and patient factors. Sixty percent (9 out of 15 cases) of bradycardia during the maintenance phase was surgery-related particularly in ophthalmologic surgery. Four cases (8.1%) of all bradycardia occurred during the emergence and recovery phase of which 78% was considered anesthesiarelated. All bradycardia had complete recovery. Sixty-three percent of events were preventable. Major contributing factors were lack of adequate knowledge (55%) and inappropriate decision-making (22%). Conclusion: Most perioperative non-hypoxic bradycardia incidences were anesthesia-related and most common during the induction phase. Improved supervision, additional training and vigilance were suggested corrective strategies.