ABSTRACT
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. Patients aged between 18-60 years and of ASA physical status 1 and 2 undergoing elective craniotomies over a period of two years 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. 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. 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