Postoperative Reintubation after Planned Extubation in Thai Anesthesia Incidents Study (THAI Study)
Thitima Chinachoti MD*, Waraporn Chau-in MD**, Suwannee Suraseranivongse MD*, Wassana Kitsampanwong MD***, Prachumpon Kongrit MD****
Affiliation : * Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University. ** Department of Anesthesiology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University *** Khon Raen Regional Hospital ****Nakhon Sri Thammarat Hospital Thailand
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.
Design : Prospective observational study
Materials and 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.
Conclusion : 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.
Keywords : Reintubation, Planned extubation, Complication
