title: Postoperative reintubation after planned extubation in Thai Anesthesia Incidents Study (THAI Study).
abstract: OBJECTIVE
  To analyze precipitating causes, outcomes and corrective strategies especially anesthetic related factors associated with reintubation after planned extubation in anesthetic technique of general anesthesia with endotracheal intubation.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Incidents of reintubation after planned extubation 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
  The total of two hundred and thirty four patients of reintubation after planned extubation (RAP) at the end of general anesthesia was reviewed in this study. The incidence of RAP was 27:10,000 and the incidence in the university hospital was similar to the tertiary and secondary care hospital. The incidence was increased in extreme age group (age < 1 and > 70 year). One hundred and fifty eight cases of RAP (67.5%) occurred in operating theater and recovery room which included 83 cases occurring within 10 minutes after extubation. The two most common primary diagnoses were upper airway obstruction and hypoventilation. Three main precipitating factors were residual effect of neuromuscular blocking and anesthetic agents (53-57%), upper airway obstruction (31%) and unstable hemodynamics (26.3%). Nearly half of RAP incidents occurring in the operating theater and recovery room were successful reextubation within six hours and 58-72 % of these two subgroups were complete recovery. The chance for prevention was more than 80% by additional training and supervision.
  
  
  CONCLUSIONS
  More than 90% of RAP occurred in operating theater and recovery room were completely or partially related to anesthetic process. Incidence of RAP could be decreased by quality assurance process of recording, reporting and modeling care process together with increase individual experience.
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. sitci@hotmail.com
authors.forename: Thitima
authors.initials: T
authors.lastname: Chinachoti
authors.forename: Waraporn
authors.initials: W
authors.lastname: Chau-in
authors.forename: Suwannee
authors.initials: S
authors.lastname: Suraseranivongse
authors.forename: Wassana
authors.initials: W
authors.lastname: Kitsampanwong
authors.forename: Prachumpon
authors.initials: P
authors.lastname: Kongrit
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D015985:Precipitating Factors; D012189:Retrospective Studies; D013785:Thailand