ABSTRACT
BACKGROUND: Risk factors for reintubation in post-anaesthetic care units related to anaesthetic processes have not previously been reported. Our goal was to identify risk factors for reintubation in general surgical patients. METHODS: A time-matched, case-control study was conducted on anaesthetic patients between 2001 and 2011. One hundred and sixty-four reintubated patients were compared with 656 randomly selected controls. RESULTS: Independent risk factors for reintubation were age <1 yr vs age 30-49 yr [odds ratio (OR)=16.4, 95% confidence interval (CI)=5.7-47.7], chronic pulmonary disease (OR=2.1, CI=1.1-4.0), preoperative hypoalbuminaemia (OR=4.9, CI=2.4-10), creatinine clearance <24 vs >60 (OR=4.1, CI=1.2-13.4), emergency case (OR=1.8, CI=1.0-3.1), operative time >3 vs <1 h (OR=3.0, CI=1.5-6.2), airway surgery (OR=32.2, CI=13.6-76), head and neck surgery (OR=3.4, CI=1.8-6.2), cardiac surgery (OR=3.8, CI=1.1-13.4), thoracic surgery (OR=6.3, CI=1.9-21.2), cardiac catheterization (OR=2.5, CI=1.1-5.5), ASA physical status III (OR=3.8, CI=1.4-10), and the use of certain types of neuromuscular blocking agent (P<0.001). CONCLUSIONS: Age <1 yr, chronic pulmonary disease, preoperative hypoalbuminaemia, and renal insufficiency were patient factors for reintubation. Emergency case, head and neck, cardiothoracic and airway surgery, and operative time >3 h were operative factors, while certain neuromuscular blocking agents and ASA physical status III were anaesthetic factors for reintubation.
Subject(s)
Airway Management/methods , Intubation, Intratracheal/methods , Postoperative Complications/epidemiology , Postoperative Complications/therapy , Adolescent , Adult , Age Factors , Aged , Analgesics, Opioid/adverse effects , Anesthesia , Anesthetics/adverse effects , Body Mass Index , Case-Control Studies , Child , Child, Preschool , Critical Care , Databases, Factual , Emergency Medical Services , Female , Humans , Hypoalbuminemia/complications , Infant , Infections/complications , Male , Middle Aged , Neuromuscular Blocking Agents/adverse effects , Pulmonary Disease, Chronic Obstructive/complications , ROC Curve , Regression Analysis , Renal Insufficiency/complications , Risk Factors , Sample Size , Smoking/adverse effects , Young AdultABSTRACT
A prospective randomized phase III trial was carried out at Songklanagarind Hospital from August 1988 to December 1990. The objectives of the study were to evaluate the effect of chemotherapy regimen in squamous cell carcinoma of the esophagus and to determine whether induction chemotherapy improves symptom-free period and survival in these patients compared to surgical treatment alone. Twenty-four patients were randomized to receive 2 cycles of chemotherapy, cis-platinum 100 mg/m2 intravenously on day 1, bleomycin 10 mg/m2 loading dose on day 3, followed by 10 mg/m2/day continuous intravenous infusion on days 4 through 7, and vinblastine 3 mg/m2 given intravenously on days 1, 8, 15, 22. The cycle was repeated on day 29. Fifteen patients completed 2 courses of chemotherapy and among these, 2 patients had a complete clinical response (13%), 6 (40%) had a partial response, and 7 patients (47%) had no response. Four patients died during chemotherapy treatment. Grade 3 hematologic toxicity (ECOG criteria) was observed in 47% (7/15) of patients. Twenty-two patients were randomized to conventional treatment (surgery alone). Median survival time was 17 months in both groups. However, early survival appeared to be better in the control group. Kaplan-Meier survivals at 6 months were 69% and 89% and at 3 years were 31% and 36% for the induction chemotherapy group and control group, respectively. The survival time differences were not statistically significant (P = 0.186). These findings demonstrate that although this chemotherapy regimen had some effect on squamous cell carcinoma of esophagus, it did not improve survival. On the contrary, survival seems to be better in the control group. The 6-month survival discrepancy between both groups might be due to the poor nutritional status of our patients, who may better tolerate smaller dosages of chemotherapy.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Esophageal Neoplasms/drug therapy , Bleomycin/administration & dosage , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/surgery , Chemotherapy, Adjuvant , Cisplatin/administration & dosage , Esophageal Neoplasms/mortality , Esophageal Neoplasms/surgery , Female , Humans , Male , Middle Aged , Prospective Studies , Survival Analysis , Thailand/epidemiology , Vinblastine/administration & dosageABSTRACT
Among 3,371 ECG (electrocardiograms) performed at Hat Yai Municipal hospital in 1981, at least 424 were done presumably for a routine preoperative investigation. Analysing the data file of each patient, it was found that 14 per cent had definitely abnormal ECGs of the type that generally implies ischemic heart disease. Another 9 per cent had ECGs that were possibly abnormal and needed, at least, a medical evaluation. However, only a fifth (22 out of 100) of those with abnormal ECGs were eventually examined and of these, less than half (9 out of 22) had their management altered. These results suggest that routine preoperative ECG lacks the potential usefulness given constraints present in several health centers in this country.
