Publication:
Reintubation in the post-anesthesia care unit [PACU] from the first 2,000 incidents: Perioperative and anesthetic adverse events in Thailand [PAAd Thai] study

0
0

Issued Date

2018

Resource Type

Article

File Type

application/pdf

ISSN

1252208

Other identifier(s)

2-s2.0-85052208636

Rights Holder(s)

มหาวิทยาลัยศรีนครินทรวิโรฒ

Bibliographic Citation

Journal of the Medical Association of Thailand. Vol 101, No.8 (2018), p.1073-1078

Suggested Citation

Tanyong A., Ratanachai P., Charuluxananan S., Atichat S., Agprudyakul S., Somchat C., Tanutanud D., Chongarunngamsang W., Boonsararuxsapong K. Reintubation in the post-anesthesia care unit [PACU] from the first 2,000 incidents: Perioperative and anesthetic adverse events in Thailand [PAAd Thai] study. Journal of the Medical Association of Thailand. Vol 101, No.8 (2018), p.1073-1078. Retrieved from: https://hdl.handle.net/20.500.14740/5551

Title

Reintubation in the post-anesthesia care unit [PACU] from the first 2,000 incidents: Perioperative and anesthetic adverse events in Thailand [PAAd Thai] study

Author(s)

Tanyong A.
 Ratanachai P.
 Charuluxananan S.
 Atichat S.
 Agprudyakul S.
 Somchat C.
 Tanutanud D.
 Chongarunngamsang W.
 Boonsararuxsapong K.

Abstract

Objective: To investigate anesthesia-related adverse events focusing on reintubation in the post-anesthesia care unit [PACU] from the Perioperative and Anesthetic Adverse Events in Thailand [PAAd Thai] Study hosted by the Royal College of Anesthesiologists of Thailand. Materials and Methods: All relevant incident reports of reintubation that occurred in the PACU out of the first 2,000 incident reports from 22 hospitals between January 1 and December 31, 2015 were reviewed by three senior anesthesiologists. Any disagreement was solved by consensus after discussion. Descriptive statistics was used. Results: There were 107 incident reports of reintubation from the 221 incidents occurring in the PACU. Forty-nine patients (45.9%) and 11 patients (10.3%) were patients with age over 60 years and younger than 10 years. Sixty-four (59.8%) cases were ASA physical status 3 and 4 while higher risk were patients in general, orthopedic, neurological, obstetric & gynecological and urological surgeries. Two-thirds of incidents occurred in service-based hospitals and in emergency condition. Usage of neuromuscular blocking agents (83.9%), midazolam (17.8%), morphine (28%), and fentanyl (73.8%) were considered as anesthesia related factors. Fifty-one percent of patients receiving non-depolarizing muscle relaxant were extubated without reversal agents. Respiratory physiologic changes, particularly oxygen desaturation (37.4%), unplanned ICU admission (33.6%), and prolonged ventilatory support (31.8%) were common outcomes. After reviewing all incidents, patients (66.4%), anesthetic (74.8%), and knowledge-based error (57.9%) were common factors while 52.3% of cases were considered as preventable. Conclusion: Incidence of reintubation in the PACU dramatically decreased over a decade. Contribution factors were human factors (inappropriate decision making, inadequate preanesthetic evaluation, and inexperience). Factor minimizing incidents were vigilance and having experience. Suggested strategies are improvement of supervision, quality assurance activity, practice guidelines, additional training, and improvement of communication. © 2018, Medical Association of Thailand. All rights reserved.

Subject(s)

Atracurium besilate
 Atropine
 Cisatracurium
 Desflurane
 Diazepam
 Fentanyl
 Glycopyrronium
 Isoflurane
 Midazolam
 Morphine
 Muscle relaxant agent
 Neostigmine
 Neuromuscular blocking agent
 Nitrous oxide
 Pancuronium
 Pethidine
 Propofol
 Sevoflurane
 Suxamethonium
 Thiopental
 Adult
 Anesthesiologist
 Article
 Assisted ventilation
 Clinical outcome
 Controlled study
 Extubation
 Female
 Heart arrest
 Hospital admission
 Human
 Incident report
 Intensive care unit
 Intubation
 Long term care
 Major clinical study
 Male
 Medical error
 Multicenter study
 Open ended questionnaire
 Oxygen desaturation
 Pediatric patient
 Perioperative period
 Practice guideline
 Recovery room
 Reintubation
 Risk assessment

View online Resources

Research Projects

Organizational Units

Journal Issue

URI

https://hdl.handle.net/20.500.14740/5551

Collections

Scopus: Year 1983-2021

Endorsement

Review

Supplemented By

Referenced By