The Thai Anesthesia Incident Monitoring Study (Thai AIMS) of post anesthetic reintubation: An analysis of 184 incident reports

Abstract

Objective: The present study was a part of the Multi-centered Study of Model of Anesthesia related Adverse Events in Thailand by Incident Report (The Thai Anesthesia Incident Monitoring Study or Thai AIMS). The objective of the present study was to determine the outcomes, contributory factors and factor minimizing incident. Material and Method: The present study was a descriptive research design. The authors extracted relevant data from the incident reports on reintubation after planned extubation after general anesthesia with endotracheal intubation from the Thai AIMS database during the study period January to June 2007. The cases were extensively reviewed by 3 reviewers for conclusion of anesthesia directly and indirectly related reintubation. Comparative analysis between two groups was done. Results: A total 184 incidents of extubation failure according to the definition were extracted in which 129 cases (70.1%) were classified as directly related to anesthesia and 55 cases (29.9%) were indirectly related to anesthesia. Oxygen desaturation occurred in 85.9% of cases while 90.2% of patients was reintubated within 2 hours after extubation. Hypoventilation (58.1%) was the commonest cause which led to reintubation directly related to anesthesia while upper airway obstruction (39.6%) was the commonest cause in the indirectly related anesthesia group. The proportion of preventable incident was 99.2% and 54.5% in directly and indirectly related anesthesia groups, respectively. Human factors particularly including lack of experience and inappropriate decision-making were considered in 99.2%, are directly related to anesthesia reintubation group. Conclusion: Extubation failure and reintubation was mostly related to anesthesia. Most of directly related to anesthesia group were considered as preventable. Human factors were also claimed as contributing factors. Quality assurance activity and improvement of supervision to improve experience and competency of decision making were suggested corrective strategies.