| ORIGINAL ARTICLE |
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| Year : 2013 | Volume
: 7
| Issue : 4 | Page : 410-414 |
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Causes of tracheal re-intubation after craniotomy: A prospective study
Surya Kumar Dube, Girija Prasad Rath, Sachidanand Jee Bharti, Ashish Bindra, Pooniah Vanamoorthy, Nidhi Gupta, Charu Mahajan, Parmod Kumar Bithal
Department of Neuroanesthesiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
Correspondence Address:
Girija Prasad Rath
Department of Neuroanesthesiology, Neurosciences Center, 6th Floor, Room # 9, All India Institute of Medical Sciences (AIIMS), New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1658-354X.121056
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Background: Re-intubation of neurosurgical patients after a successful tracheal extubation in the operating room is not uncommon. However, no prospective study has ever addressed this concern. This study was aimed at analyzing various risk factors of re-intubation and its effect on patient outcome. Methods: Patients aged between 18-60 yrs and of ASA physical status I and II undergoing elective craniotomies over a period of two yrs were included. A standard anesthetic technique using propofol, fentanyl, rocuronium, and isoflurane/sevoflurane was followed, in all these patients. 'Re-intubation' was defined as the necessity of tracheal intubation within 72 hrs of a planned extubation. Data were collected and analyzed employing standard statistical methods. Results: One thousand eight hundred and fifty patients underwent elective craniotomy, of which 920 were included in this study. A total of 45 (4.9%) patients required re-intubation. Mean anesthesia duration and time of re-intubation were 6.3±1.8 and 24.6±21.9 hrs, respectively. The causes of re-intubation were neurological deterioration (55.6%), respiratory distress (22.2%), unmanageable respiratory secretion (13.3%), and seizures (8.9%). The most common post-operative radiological (CT scan) finding was residual tumor and edema (68.9%). Seventy-three percent of the re-intubated patients had satisfactory post-operative cough-reflex. The ICU and hospital stay, and Glasgow outcome scale at discharge were not significantly affected by different causes of re-intubation. Conclusion: Neurological deterioration is the most common cause of re-intubation following elective craniotomies owing to residual tumor and surrounding edema. A satisfactory cough reflex may not prevent subsequent re-intubation in post-craniotomy patients. |
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