Prolonged time to extubation after general anaesthesia is associated with early escalation of care

Abstract

BACKGROUND Prolonged time to extubation after general anaesthesia has been defined as a time from the end of surgery to airway extubation of at least 15 min. This occurrence can result in ineffective utilisation of operating rooms and delays in patient care. It is unknown if unanticipated delayed extubation is associated with escalation of care. OBJECTIVES To assess the frequency of ‘prolonged extubation’ after general anaesthesia and its association with ‘escalation of care before discharge from the postanaesthesia care unit’, defined as administration of reversal agents for opioids and benzodiazepines, airway re-intubation and need for ventilatory support. In addition, we tried to identify independent factors associated with ‘prolonged extubation’. DESIGN Single-centre retrospective study of cases performed from 1 January 2010 to 31 December 2014. SETTING A large US tertiary academic medical centre. PATIENTS Adult general anaesthesia cases excluding cardiothoracic, otolaryngology and neurosurgery procedures, classified as: Group 1 – regular extubation (≤15 min); Group 2 – prolonged extubation (≥16 and ≤60 min); Group 3 – very prolonged extubation (≥61 min). MAIN OUTCOME MEASURES First, cases with prolonged time to extubation; second, instances of escalation of care per extubation group; third, independent factors associated with prolonged time to extubation. RESULTS A total of 86 123 cases were analysed. Prolonged extubation occurred in 8138 cases (9.5%) and very prolonged extubation in 357 cases (0.4%). In Groups 1, 2 and 3 respectively, naloxone was used in 0.4, 4.1 and 3.9% of cases, flumazenil in 0.03, 0.6 and 2% and respiratory support in 0.2, 0.7 and 2%, and immediate re-intubation occurred in 0.1, 0.3 and 2.8% of cases. Several patient-related, anaesthesia-related and procedure-related factors were independently associated with prolonged time to extubation. CONCLUSION Prolonged time to extubation occurred in nearly 10% of cases and was associated with an increased incidence of escalation of care. Many independent factors associated with ‘prolonged extubation’ were nonmodifiable by anaesthetic management.

Longer time to extubation after general anesthesia with desflurane in patients with obstructive respiratory dysfunction: a retrospective study

“…These data suggest the possibility that volatile anesthetics including desflurane may not exert bronchodilating effects or even may increase the respiratory resistance in patients with COPD or in smokers. Although the proportion of current smokers was similar between the two groups in this study, desflurane may not show bronchodilating effects or increase Several studies reported that age, BMI, and operation time were associated with prolonged extubation after general anesthesia including general anesthesia induced by volatile agents [13,14]. It has been shown that emergence and/or recovery from anesthesia are faster with desflurane than with sevoflurane, even in obese patients or elderly patients who are at higher risk for prolonged extubation [3,4,15].…”

Narrative Review of Prolonged Times to Tracheal Extubation After General Anesthesia With Intubation and Extubation in the Operating Room

“…12–19 Thus, the current review was based on 19 articles obtained using Web of Science title and abstract search. 1–19…”

A novel nomogram for predicting the decision to delayed extubation after thoracoscopic lung cancer surgery

“…However, to date, no document has researched predictors for delayed extubation after thoracoscopic lung cancer surgery. Besides, many of the published factors associated with delayed extubation cannot be modified [ 18 ]. Further, no effective and well-performing model was established for predicting the possibility of delayed extubation.…”

“…Therefore, by reviewing a large number of medical records, this study aims to explore the incidence and potential predictors and to construct a nomogram to predict the decision to delayed extubation after this surgery. Moreover, considering the reported influence of timing of operation and attending handoff on delayed extubation in other surgical specialties [ 9 , 18 , 19 ], this study also attempts to investigate the interaction of the two factors on delayed extubation.…”