The Thai Anesthesia Incident Monitoring Study (Thai AIMS) of Post Anesthetic Reintubation: An Analysis of 184 Incident Reports
Thitima Chinachoti MD*, Sujaree Poopipatpab MD**, Supaporn Buranatrevedhya MD***, Kanok Taratarnkoolwatana MD****, Thewarug Werawataganon MD*****, Prasatnee Jantorn MD******
Affiliation : * Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok ** Department of Anesthesiology, Bangkok Metropolitan Administration Medical College and Vachira Hospital, Bangkok *** Department of Anesthesiology, Rajavithi Hospital, Bangkok, **** Department of Anesthesiology, Ratchaburi Hospital, Ratchaburi ***** Department of Anesthesiology, Chulalongkorn University, Bangkok ****** Department of Anesthesiology, Ramathibodi Hospital, Mahidol University, Bangkok
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.
Keywords : Reintubation, Complication, Anesthesia, incident report, Extubation failure
