Factors affecting delayed extubation after intracranial surgery in Siriraj Hospital.

ABSTRACT

Background: The time to extubation in neurosurgical patients depends on a number of various factors, including patient, surgical and anesthetic factors. Objective: To determine the factors influencing the time to extubation in neurosurgical patients. Methods: This study is a prospective study including all patients who underwent intracranial surgery from October 2008 to April 2009 at Siriraj Hospital. We excluded patients who were under the age of 18 years, intubated or had undergone tracheostomy prior to the surgery and had a history of difficult intubation. Demographic data and various factors expected to involve the extubation were collected and analyzed. Results: There were 171 (89.1%) patients suitable for the early extubation and 21 (10.9%) patients remained in the intubated condition. A univariate analysis revealed 10 factors influencing failure of the extubation, including age >65 years, ASA physical status > class II, Glasgow coma score (GCS) <13, emergency surgical condition, anesthetic time >300 minutes, estimated blood loss >700 ml, use of cerebral protective technique, total propofol dosage >1,000 mg, total fentanyl dosage >50 mcg/hour, and a completed operation time after 4 pm. In a multivariate analysis, the delayed extubation was associated with 3 factors, including GCS <13, emergency surgical condition and estimated blood loss >700 ml. Conclusion: The incidence of the early extubation in neurosurgical patients who underwent intracranial surgery was 89.1%. Factors associated with an increased risk of delayed extubation included low Glasgow coma score, emergency surgical status and a large amount of intra-operative blood loss.