Analysis of Reintubation at Postanesthesia Care Unit of a Teaching Hospital

某教學醫院在恢復室重新插管事件分析

盧正淵(Cheng-Yuan Lu) ； 謝紹維(Shao-Wei Hsieh) ； 林聖瀚(Sheng-Han Lin) ； 施勳彰(Hsun-Chang Shih) ； 楊寧正(Lin-Cheng Yang)

《北市醫學雜誌》 12卷3期 (2015/09) Pp. 17-23

https://doi.org/10.6200/TCMJ.2015.12.3.03

摘要

目的：手術後在恢復室重新插管是很嚴重的事件，我們想要探討其發生率及分析原因並建立原因別分類系統。方法：恢復室重新插管定義為，全身麻醉手術接受氣管內插管，在術後計畫性拔管失敗，於恢復室再次插管。重插管的案例由義大醫院麻醉部品管資料庫中2010到2013年資料獲取，分析原因並做分類。結果：總共85,678案例接受麻醉，其中70,906案例接受氣管插管式全身麻醉，其中有24例在恢復室重新插管（重插管率0.034%）。重插管原因可以分成五大類。呼吸道和頭頸部手術（n=6）、麻醉藥影響（n=4）以及血液動力學不穩定（n=8）為主要的三大類原因。第四類呼吸問題範圍很大，但是我們可以把它簡化，再細分為呼吸不足（n=6）、呼吸阻塞（n=0）以及喉頭痙攣／支氣管痙攣（n=0）。第五類為其它類別包括氣管內管本身問題（n=0）、以及原因不明或無法歸類（n=0）。呼吸衰竭通常發生在拔管後40分鐘之內。結論：研究結果可以幫助我們容易全盤了解重新插管的原因，進而可以預防拔管失敗。

關鍵字

重新插管 ； 手術後 ； 麻醉後 ； 恢復室 ； 麻醉後加護中心

並列摘要

The need for reintubation in postanesthesia care unit (PACU) after general anesthesia means the occurrence of serious complications. We investigated the incidence, reasons and risk factors of reintubation and developed a risk classification system. Methods: Reintubation was defined as the need for endotracheal intubation in postanesthesia care unit after the planned extubation of the initial intubation for general anesthesia. Data on patients who required reintubation during the period 2010 to 2013 were retrospectively extracted from the Quality Assurance database of the Department of Anesthesiology, E-DA Hospital. The incidence, reasons and risk factors of reintubation were analyzed and classified. Results: During the study period, 85,678 patients underwent general anesthesia at our institution. Of them, 70,906 required endotracheal intubation or placement of a laryngeal mask airway, and 24 (0.034%) of them required reintubation in the PACU. The reasons for reintubation were classified into 5 major groups, namely, airway and head-neck surgery group (n=6), residual anesthetic effects group (n=4), unstable hemodynamics group (n=8), respiratory problems group and other group. The respiratory group can be subcategorized into respiratory insufficiency (n=6), respiratory obstruction (n=0) and laryngospasm/bronchospasm (n=0). The other group can subcategorized into endotracheal tube problems (n=0) and unknown etiology (n=0). Respiratory failure tended to occur within 40 minutes after extubation. Conclusion: The results help the anesthesiologists to identify the reasons and risk factors of reintubation, and thus prevent the failure of extubation.

並列關鍵字

reintubation ； postoperative ； postanesthesia ； PACU ； POR