ABSTRACT
Background: Cervical spine surgery brings up great concerns about post operative severe complications and morbidities. Anesthesiologists should know contributing factors for the delayed extubation which includes patient factors, surgical factors, and anesthetic factors. Objective: To study the factors related to delayed extubation for the benefit of anesthetists’ future decision making and the patients’ safety. Methods: Case-controlled study in a retrospective fashion. Patients who undertook cervical spine surgery during 2002 - 2007 without previous intubation, tracheostomy, and ones with data available to be collected; were identified for the study. Data included age, sex, BMI, ASA classification, smoking history, pre-operative neurological deficit, history of previous C-spine surgery, steroid administration, number of cervical spine surgeries, upper cervical level including, surgical approach, instruments, intubation technique, duration of the operation, total blood loss, and total fluid replacement. All 16 factors were studied and analyzed for their relationship to extubation difficulty. Results: Of all 140 patients identified in the study, 70 were patients with immediate extubation and 70 were patients with delayed extubation. Factors that are statistically significant in delayed extubation are: advancing age >60 years, ASA classification > class 2, preoperative neurological deficit, surgery >2 levels of spines, duration of the operation >180 minutes, fiberoptic intubation technique, total fluid administration >4,000 ml during surgery and total blood loss >250 ml. When analyzed with multivariate analysis, factors that related to delayed extubation are advancing age >60 years (odds ratio 4.077, 95% CI 1.562-10.641), neurological deficit (odds ratio 5.719, 95% CI 1.312-24.927), surgery >2 levels of spines (odds ratio 4.108, 95% CI 1.672-10.095), duration of operation >180 minutes (odds ratio 4.538, 95% CI 1.687-12.205), and fiberoptic intubation technique (odds ratio 4.131, 95% CI 1.636-10.433). Conclusion: There are 5 contributively factors that are related to delayed extubation in patients receiving cervical spine surgery at Siriraj Hospital: advancing age > 60 years, neurological deficit, surgery >2 levels of cervical spines, duration of the operation >180 minutes, and fiberoptic intubation technique.