Unplanned Intubation during Anesthesia: Review of 31 Cases from The Thai Anesthesia Incidents Study (THAI Study)
Waraporn Chau-In MD*, Thitima Chinachoti MD**, Yodying Punjasawadi MD***, Sireeluck Klanarong MD****, Kanok Taratarnkoolwatana MD*****
Affiliation : * Department of Anesthesiology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen ** Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University *** Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai **** Department of Anesthesiology, Faculty of Medicine, Buddhachinaraj Hospital, ***** Department of Anesthesiology, Faculty of Medicine, Rajburi Hospital, Rajburi
Objectives : To examine the causes, outcomes, and contributing factors associated with patients requiring
unplanned emergency intubation for adverse respiratory events.
Meterial and Method: Appropriate unplanned intubation incidents were extracted from the Thai Anesthesia
Incidents Study (THAI Study) database conducted between February 1, 2003, and January 31, 2004, and
analyzed using descriptive statistics.
Results : Thirty-one incidents of unplanned intubation were recorded, 21 of which were due to respiratory
problems particularly after bronchoscopy with and without surgery of the upper airway. Six of the 21 cases
(28.6%) were children under 10 years of age who suffered from papilloma of the larynx. Sixteen cases of the 31
cases (52%) of the unplanned intubations were due to inadequate ventilation; 13 cases (41%) due to laryngeal
edema; 11 cases (36%) due to sedative agents. The other events were the result of unstable hemodynamics,
severe metabolic acidosis, muscle relaxants, and intrapulmonary lesions. Eighteen cases of unplanned
intubations (18/31) (58%) occurred in the Post-Anesthesia Care Unit, 5 cases (16%) in a ward, and 4 (13%)
in the operating room. The reported contributing factors included inadequate experience, lack of supervision
and the patient’s condition.
Conclusion : Major incidents of unplanned intubation occurred after bronchoscopy. Common contributing
factors related to inadequate ventilation, airway obstruction, sedative agents and unstable hemodynamics.
Quality assurance, additional training, and improved supervision tended to minimize the incidents.
Keywords : Anesthesia, Intubation, Risk factors, Unplanned, Complications
