An analysis of reintubations from a quality assurance database of 152,000 cases.
OBJECTIVE
To determine if the majority of reintubations, a potentially preventable adverse event, were predominantly due to residual muscle relaxant effects, we analyzed our quality assurance database to identify the causes of reintubation.


METHODS
Retrospective study.


METHODS
University of Michigan Department of Anesthesiology Quality Assurance (QA) database.


METHODS
We analyzed QA records from 152,939 anesthetic cases performed from 1994 to 1999 at our institution. Of these cases, 107,317 were performed with a general anesthetic. The medical record of each patient requiring reintubation was obtained and reviewed to determine the cause of the reintubation.


RESULTS
A total of 191 reintubation events were identified. One hundred twelve of the 191 (59%) reintubations were due to respiratory problems; 11 of the 191 (6%) reintubations were due to complications of neuromuscular blocking drug use. Other causes were unintentional extubation, surgical complication, endotracheal tube problems, and cardiac problems. One hundred five reintubations (105/191, 55%) occurred in the operating room and 86 (86/191, 45%) occurred in the postanesthesia care unit.


CONCLUSIONS
Respiratory complications were the most common cause of reintubation in the perioperative period. Complications related to the neuromuscular blocking drugs were the fourth most common cause of reintubation. More reintubations occurred in the operating room than the postanesthesia care unit. Muscle relaxant effect and opioid effect are rare causes of respiratory failure in the anesthetized patient in the immediate postoperative period.
Lee
Peter J
PJ
Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI 48109-0048, USA. peterlee@umich.edu
MacLennan
Allison
A
Naughton
Norah N
NN
O'Reilly
Michael
M
D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D000769:Anesthesia, Inhalation / Q000009:adverse effects* / Q000706:statistics & numerical data; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D016208:Databases, Factual; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation / Q000706:statistics & numerical data; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects; D011785:Quality Assurance, Health Care; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D009466:Neuromuscular Blocking Agents