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Risk Factors for Postoperative Unplanned Reintubation in a Cohort of Patients Undergoing General Anesthesia

Background Unplanned post-operative reintubation (UPR) is a complication of general anesthesia (GA) that can be associated with worsened outcomes. Objective Evaluate characteristics associated with UPR in patients undergoing procedures under GA. Methods Patients over the age of 18 undergoing surgica...

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Autores principales: Sofjan, Iwan, Vazquez, Sima, Dominguez, Jose, Sekhri, Nitin, Wecksell, Matthew, Samuel, Barst M, Salik, Irim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10257981/
https://www.ncbi.nlm.nih.gov/pubmed/37309339
http://dx.doi.org/10.7759/cureus.38949
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author Sofjan, Iwan
Vazquez, Sima
Dominguez, Jose
Sekhri, Nitin
Wecksell, Matthew
Samuel, Barst M
Salik, Irim
author_facet Sofjan, Iwan
Vazquez, Sima
Dominguez, Jose
Sekhri, Nitin
Wecksell, Matthew
Samuel, Barst M
Salik, Irim
author_sort Sofjan, Iwan
collection PubMed
description Background Unplanned post-operative reintubation (UPR) is a complication of general anesthesia (GA) that can be associated with worsened outcomes. Objective Evaluate characteristics associated with UPR in patients undergoing procedures under GA. Methods Patients over the age of 18 undergoing surgical procedures under GA were extracted from our institution's electronic medical record. Patient baseline, procedural, and anesthesia characteristics were evaluated for associations with UPR. Results In 29,284 surgical procedures undergoing GA, there were 29 (0.1%) patients that required UPR. The most common surgical service with UPR was otolaryngology; the most common surgical positioning was supine. When controlling for operative time and case complexity, UPR was predicted by high-dose opioids, defined as opioid administration greater than the 75th percentile of our institutional cohort. Prolonged operative time, estimated blood loss (EBL), body mass index (BMI), extubation time after reversal, or age were not independently associated with UPR. Conclusion Our analysis revealed that high-dose opioid administration is independently associated with intraoperative UPR. Awareness of patients at the highest risk for UPR along with provider education regarding techniques to avoid respiratory depression in this patient population is essential in reducing patient morbidity and mortality. This knowledge will help guide perioperative physicians in medical optimization, appropriate selection of intraoperative analgesics, and cautious extubation criteria to ensure patient safety.
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spelling pubmed-102579812023-06-12 Risk Factors for Postoperative Unplanned Reintubation in a Cohort of Patients Undergoing General Anesthesia Sofjan, Iwan Vazquez, Sima Dominguez, Jose Sekhri, Nitin Wecksell, Matthew Samuel, Barst M Salik, Irim Cureus Anesthesiology Background Unplanned post-operative reintubation (UPR) is a complication of general anesthesia (GA) that can be associated with worsened outcomes. Objective Evaluate characteristics associated with UPR in patients undergoing procedures under GA. Methods Patients over the age of 18 undergoing surgical procedures under GA were extracted from our institution's electronic medical record. Patient baseline, procedural, and anesthesia characteristics were evaluated for associations with UPR. Results In 29,284 surgical procedures undergoing GA, there were 29 (0.1%) patients that required UPR. The most common surgical service with UPR was otolaryngology; the most common surgical positioning was supine. When controlling for operative time and case complexity, UPR was predicted by high-dose opioids, defined as opioid administration greater than the 75th percentile of our institutional cohort. Prolonged operative time, estimated blood loss (EBL), body mass index (BMI), extubation time after reversal, or age were not independently associated with UPR. Conclusion Our analysis revealed that high-dose opioid administration is independently associated with intraoperative UPR. Awareness of patients at the highest risk for UPR along with provider education regarding techniques to avoid respiratory depression in this patient population is essential in reducing patient morbidity and mortality. This knowledge will help guide perioperative physicians in medical optimization, appropriate selection of intraoperative analgesics, and cautious extubation criteria to ensure patient safety. Cureus 2023-05-12 /pmc/articles/PMC10257981/ /pubmed/37309339 http://dx.doi.org/10.7759/cureus.38949 Text en Copyright © 2023, Sofjan et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Anesthesiology
Sofjan, Iwan
Vazquez, Sima
Dominguez, Jose
Sekhri, Nitin
Wecksell, Matthew
Samuel, Barst M
Salik, Irim
Risk Factors for Postoperative Unplanned Reintubation in a Cohort of Patients Undergoing General Anesthesia
title Risk Factors for Postoperative Unplanned Reintubation in a Cohort of Patients Undergoing General Anesthesia
title_full Risk Factors for Postoperative Unplanned Reintubation in a Cohort of Patients Undergoing General Anesthesia
title_fullStr Risk Factors for Postoperative Unplanned Reintubation in a Cohort of Patients Undergoing General Anesthesia
title_full_unstemmed Risk Factors for Postoperative Unplanned Reintubation in a Cohort of Patients Undergoing General Anesthesia
title_short Risk Factors for Postoperative Unplanned Reintubation in a Cohort of Patients Undergoing General Anesthesia
title_sort risk factors for postoperative unplanned reintubation in a cohort of patients undergoing general anesthesia
topic Anesthesiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10257981/
https://www.ncbi.nlm.nih.gov/pubmed/37309339
http://dx.doi.org/10.7759/cureus.38949
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