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

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.