title: Causes of tracheal re-intubation after craniotomy: A prospective study.
abstract: BACKGROUND
  Re-intubation of neurosurgical patients after a successful tracheal extubation in the operating room is not uncommon. However, no prospective study has ever addressed this concern. This study was aimed at analyzing various risk factors of re-intubation and its effect on patient outcome.
  
  
  METHODS
  Patients aged between 18-60 yrs and of ASA physical status I and II undergoing elective craniotomies over a period of two yrs were included. A standard anesthetic technique using propofol, fentanyl, rocuronium, and isoflurane/sevoflurane was followed, in all these patients. 'Re-intubation' was defined as the necessity of tracheal intubation within 72 hrs of a planned extubation. Data were collected and analyzed employing standard statistical methods.
  
  
  RESULTS
  One thousand eight hundred and fifty patients underwent elective craniotomy, of which 920 were included in this study. A total of 45 (4.9%) patients required re-intubation. Mean anesthesia duration and time of re-intubation were 6.3±1.8 and 24.6±21.9 hrs, respectively. The causes of re-intubation were neurological deterioration (55.6%), respiratory distress (22.2%), unmanageable respiratory secretion (13.3%), and seizures (8.9%). The most common post-operative radiological (CT scan) finding was residual tumor and edema (68.9%). Seventy-three percent of the re-intubated patients had satisfactory post-operative cough-reflex. The ICU and hospital stay, and Glasgow outcome scale at discharge were not significantly affected by different causes of re-intubation.
  
  
  CONCLUSIONS
  Neurological deterioration is the most common cause of re-intubation following elective craniotomies owing to residual tumor and surrounding edema. A satisfactory cough reflex may not prevent subsequent re-intubation in post-craniotomy patients.
authors.affiliation: Department of Neuroanesthesiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Surya Kumar
authors.initials: SK
authors.lastname: Dube
authors.affiliation: Department of Neuroanesthesiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Girija Prasad
authors.initials: GP
authors.lastname: Rath
authors.affiliation: Department of Neuroanesthesiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Sachidanand Jee
authors.initials: SJ
authors.lastname: Bharti
authors.affiliation: Department of Neuroanesthesiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Bindra
authors.affiliation: Department of Neuroanesthesiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Pooniah
authors.initials: P
authors.lastname: Vanamoorthy
authors.affiliation: Department of Neuroanesthesiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Department of Neuroanesthesiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Charu
authors.initials: C
authors.lastname: Mahajan
authors.affiliation: Department of Neuroanesthesiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Parmod Kumar
authors.initials: PK
authors.lastname: Bithal
keywords: Craniotomy; extubation failure; outcome; post-operative; tracheal re-intubation