Unplanned intubation during anesthesia: review of 31 cases from the Thai Anesthesia Incidents Study (THAI study).
OBJECTIVE
To examine the causes, outcomes, and contributing factors associated with patients requiring unplanned emergency intubation for adverse respiratory events. METERIAL AND METHOD: Appropriate unplanned intubation incidents were extracted from the Thai Anesthesia Incidents Study (THAI Study) database conducted between February 1, 2003, and January 31, 2004, and analyzed using descriptive statistics.


RESULTS
Thirty-one incidents of unplanned intubation were recorded, 21 of which were due to respiratory problems particularly after bronchoscopy with and without surgery of the upper airway. Six of the 21 cases (28.6%) were children under 10 years of age who suffered from papilloma of the larynx. Sixteen cases of the 31 cases (52%) of the unplanned intubations were due to inadequate ventilation; 13 cases (41%) due to laryngeal edema; 11 cases (36%) due to sedative agents. The other events were the result of unstable hemodynamics, severe metabolic acidosis, muscle relaxants, and intrapulmonary lesions. Eighteen cases of unplanned intubations (18/31) (58%) occurred in the Post-Anesthesia Care Unit, 5 cases (16%) in a ward, and 4 (13%) in the operating room. The reported contributing factors included inadequate experience, lack of supervision and the patient's condition.


CONCLUSIONS
Major incidents of unplanned intubation occurred after bronchoscopy. Common contributing factors related to inadequate ventilation, airway obstruction, sedative agents and unstable hemodynamics. Quality assurance, additional training, and improved supervision tended to minimize the incidents.
Department of Anesthesiology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen 40002, Thailand.
Waraporn
W
Chau-In
Thitima
T
Chinachoti
Yodying
Y
Punjasawadi
Sireeluck
S
Klanarong
Kanok
K
Taratarnkoolwatana
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000175:diagnosis* / Q000453:epidemiology; D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D001999:Bronchoscopy / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012042:Registries; D018570:Risk Assessment; D017678:Sex Distribution; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome