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Abstracts and Programme, EUROANAESTHESIA 2008: Evidence-Based Practice and Quality Assurance

Reintubation in the postanesthesia care unit: An analysis from a database of 21,349 cases at Chiang Mai University Hospital, Thailand

1AP1-7

Bunchungmongkol, N.; Pipanmekaporn, T.; Punjasawadwong, Y.; Cenpakdee, S.

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European Journal of Anaesthesiology (EJA): May-June 2008 - Volume 25 - Issue - p 8
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Background and Goal of Study: Reintubation is one of the major problems in postanesthesia care unit (PACU) with the incidences ranging from 0.17%-0.45%. The objective of this study was to determine the incidence, causes, risk factors and suggestive preventive strategies of reintubation in PACU.

Materials and Methods: We conducted a retrospective analytical study of 21,349 patients extubated after general anesthesia from 2004 to 2006. Patients requiring reintubation in PACU were identified and reviewed. Descriptive statistics were used to summarize the data. Univariate and multivariate analysis were used to identify risk factors.

Results and Discussion: Fifty nine of the 21,349 patients extubated after general anesthesia were reintubated in PACU (27.6: 10,000 (95%CI: 21.9, 34.3)). Eighty four percent of reintubations occurred within 1 hour after extubation or admission to the PACU. The main causes of reintubations were airway obstruction (32%) and inadequate ventilation associated with residual effect of muscle relaxant and or excessive sedation (30%). Fifty five percent of incidents were anesthesia- related, whereas 40% were patient- related. The potential risk factors were age > 50 years, ASA physical status class 3-5, emergency status and abdominal surgery. The common contributory factors were inexperience and inappropriate decisions of personnel. The suggestive preventive strategies included the use of neuromuscular monitoring, improvement in supervision, additional training and clinical practice guidelines.

Conclusion(s): Over half of the reintubations (55%) in PACU were related to anesthesia care and anesthetic agents. The appropriate use of muscle relaxants, increased use of neuromuscular monitoring, setting up clinical practice guidelines for extubation and improving airway care are the suggestive preventive strategies.

References:

Chinachoti T, Chau-in W, Suraseranivongse S, et al. J Med Assoc Thai 2005; 88 Suppl 7:S84—94.
    Lee PJ, MacLennan A, Naughton NN, et al. J Clin Anesth 2003; 15(8): 575—81.
      © 2008 European Society of Anaesthesiology