Related Experiment Video
Updated: Aug 29, 2026
Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
An analysis of reintubations from a quality assurance database of 152,000 cases
Peter J Lee1, Allison MacLennan, Norah N Naughton
1Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI 48109-0048, USA. peterlee@umich.edu
Study Objective:
To determine if the majority of reintubations, a potentially preventable adverse event, were predominantly due to residual muscle relaxant effects, we analyzed our quality assurance database to identify the causes of reintubation.
Design:
Retrospective study.
Setting:
University of Michigan Department of Anesthesiology Quality Assurance (QA) database.
Measurements:
We analyzed QA records from 152,939 anesthetic cases performed from 1994 to 1999 at our institution. Of these cases, 107,317 were performed with a general anesthetic. The medical record of each patient requiring reintubation was obtained and reviewed to determine the cause of the reintubation.
Results:
A total of 191 reintubation events were identified. One hundred twelve of the 191 (59%) reintubations were due to respiratory problems; 11 of the 191 (6%) reintubations were due to complications of neuromuscular blocking drug use. Other causes were unintentional extubation, surgical complication, endotracheal tube problems, and cardiac problems. One hundred five reintubations (105/191, 55%) occurred in the operating room and 86 (86/191, 45%) occurred in the postanesthesia care unit.
Conclusion:
Respiratory complications were the most common cause of reintubation in the perioperative period. Complications related to the neuromuscular blocking drugs were the fourth most common cause of reintubation. More reintubations occurred in the operating room than the postanesthesia care unit. Muscle relaxant effect and opioid effect are rare causes of respiratory failure in the anesthetized patient in the immediate postoperative period.
Insights
Most reintubations after anesthesia are due to respiratory issues, not muscle relaxants. This study analyzed reintubation causes to improve patient safety and reduce adverse events.
Area of Science:
- Anesthesiology
- Patient Safety
- Quality Improvement
Background:
- Reintubation is a critical adverse event in perioperative care.
- Identifying the primary causes of reintubation is essential for developing targeted interventions.
- Residual neuromuscular blocking drug effects are a suspected, but not fully understood, contributor to reintubation.
Purpose of the Study:
- To investigate the predominant causes of reintubation in patients undergoing general anesthesia.
- To determine the frequency of reintubation attributed to residual muscle relaxant effects.
- To analyze the timing and location of reintubation events.
Main Methods:
- Retrospective analysis of a quality assurance database from a university anesthesiology department.
- Inclusion of 152,939 anesthetic cases (107,317 general anesthetics) from 1994 to 1999.
- Review of medical records for 191 patients requiring reintubation to ascertain the cause.
Main Results:
- Respiratory problems were the leading cause of reintubation (59%).
- Complications from neuromuscular blocking drugs accounted for 6% of reintubations.
- Reintubations occurred more frequently in the operating room (55%) than the postanesthesia care unit (45%).
Conclusions:
- Respiratory complications are the primary driver of perioperative reintubations.
- Neuromuscular blocking drug complications are a less common cause of reintubation.
- Targeted strategies focusing on respiratory management are crucial for reducing reintubation rates.
Related Concept Videos
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals.
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...