RESUMO
Background and Aims: Postanesthetic reintubation is associated with increased morbidities and mortality; however, it can be reduced with defined predictors and using a score as a tool. This study aimed to identify independent predictors and develop a reliable predictive score. Material and Methods: A retrospective, time-matched, case control study was conducted on patients who underwent general anesthesia between October 2017 and September 2021. Using stepwise multivariable logistic regression analysis, predictors were determined and the predictive score was developed and validated. Results: Among 230 patients, 46 were in the reintubated group. Significant independent predictors included age >65 years (odds ratio [OR] 2.96 [95% confidence interval {CI} 1.23, 7.10]), the American Society of Anesthesiologists physical status III-IV (OR 6.60 [95%CI 2.50 17.41]), body mass index (BMI) ≥30 kg/m2 (OR 4.91 [95% CI 1.55, 15.51]), and head and neck surgery (OR 4.35 [95% CI 1.46, 12.87]). The predictive model was then developed with an area under the receiver operating characteristic curve (AUC) of 0.84 (95% CI 0.78, 0.90). This score ranged from 0 to 29 and was classified into three subcategories for clinical practicability, in which the positive predictive values were 6.01 (95% CI 2.63, 11.50) for low risk, 18.64 (95% CI 9.69, 30.91) for moderate risk, and 71.05 (95% CI 54.09, 84.58) for high risk. Conclusion: The independent predictors for postanesthetic reintubation according to this simplified risk-based scoring system designed to aid anesthesiologists before extubation were found to be advanced age, higher American Society of Anesthesiologists physical status, obesity, and head and neck surgery.
RESUMO
The aim of this study was to identify the characteristics of perioperative convulsion and to suggest possible correcting strategies. The multi-centre study was conducted prospectively in 22 hospitals across Thailand in 2015. The occurrences of perioperative adverse events were collected. The data was collated by site manager and forwarded to the data management unit. All perioperative convulsion incidences were enrolled and analysed. The consensus was documented for the relevant factors and the corrective strategies. Descriptive statistics were used. From 2,000 incident reports, perioperative convulsions were found in 16 patients. Six episodes (37.5%) were related to anaesthesia, 31.3% to patients, 18.8% to surgery, and 12.5% to systemic processes. The contributing factor was an inexperienced anaesthesia performer (25%), while the corrective strategy was improvements to supervision (43.8%). Incidents of perioperative convulsion were found to be higher than during the last decade. The initiation and maintenance of safe anaesthesia should be continued.
