Analysis of Reintubation at Postanesthesia Care Unit of a Teaching Hospital

The need for reintubation in postanesthesia care unit (PACU) after general anesthesia means the occurrence of serious complications. We investigated the incidence, reasons and risk factors of reintubation and developed a risk classification system. Methods: Reintubation was defined as the need for endotracheal intubation in postanesthesia care unit after the planned extubation of the initial intubation for general anesthesia. Data on patients who required reintubation during the period 2010 to 2013 were retrospectively extracted from the Quality Assurance database of the Department of Anesthesiology, E-DA Hospital. The incidence, reasons and risk factors of reintubation were analyzed and classified. Results: During the study period, 85,678 patients underwent general anesthesia at our institution. Of them, 70,906 required endotracheal intubation or placement of a laryngeal mask airway, and 24 (0.034%) of them required reintubation in the PACU. The reasons for reintubation were classified into 5 major groups, namely, airway and head-neck surgery group (n=6), residual anesthetic effects group (n=4), unstable hemodynamics group (n=8), respiratory problems group and other group. The respiratory group can be subcategorized into respiratory insufficiency (n=6), respiratory obstruction (n=0) and laryngospasm/bronchospasm (n=0). The other group can subcategorized into endotracheal tube problems (n=0) and unknown etiology (n=0). Respiratory failure tended to occur within 40 minutes after extubation. Conclusion: The results help the anesthesiologists to identify the reasons and risk factors of reintubation, and thus prevent the failure of extubation.