1、Early ubation is a relatively rare toperative period of surgeries and lanned extubation, with reported rates of he tanesthesia care unit (PACU) n 0.1% and 0.45%. Reasons for ubation include Early ubation is a relatively rare toperative period of surgeries and lanned extubation, with reported rates o

2、f he tanesthesia care unit (PACU) n 0.1% and 0.45%. Reasons for ubation include respiratory insufficiency, airway obstruction, prolongedneuromuscular blockade,and sideeffectsof “Airway obstruction” (all causes) is the most common cause of airway-eventsand need for he toperativesetting. Afrequent cau

3、se airway obstruction leading to early extubation failure both in anesthesia and ICU patients is laryngeal edema, generally observed within 1 hour of extubation and rarely observed after 24 hours. Fewer data are available on the causes of toperative setting; patient comorbidities, type of surgery, t

4、operative management may all becontributingIn a retrospective review of 13,000 consecutive PACU s published 1990, Mathew et al. observed 26 emergent ubation events (0.19% series, ubations occurred in a heterogeneous group of patients, more after head and neck surgery, and the mainrecognized contribu

5、ting factor medical events were classified as “preventable,” as the 2 most common causes of ubation were found to be persistent sedative and muscle relaxant effect, inappropriate fluid erestingly, the same investigators t“all patients were eventually discharged from the hospital without sequelae of

6、these events,”implying amodera ysevereimpact of extubation failureonpatients clinical The 1985 to 1999 ASA Closed Claims ysis offers a very on the severity of extubation- related complications. Of the 26 claims from events after tracheal extubation, 21 cases (81%) resulted in either death or brain d

7、amage. Notably, the majority of the patients involved were obese (15 of 26). Over the same period, 104 claimsrelated to events at induction of anesthesia were of which 50 (48%) resulted in death or brain erestingly, although authors of ysis were able to ignificant decrease in after events at anesthe

8、sia induction over the years(from 62% in 19851992 to 35% in 19931999), the same did not hold true for adverse events after extubation. recently surveyed the ASA Closed Claims Project databaseb and were tamong the 47 claims for ubation on anesthesia induction since 2000, (43%) resulted in death or pe

9、rmanent brain damage. t trend toward reduced death/brain damage reported by Peterson et al. appears to be continuing. Among claims for failed extubation reported since 2000, death and permanent brain damage occurred in 15 of 16 claims (94%), and there were 8 with difficult airway t he recovery all (

10、100%) resulting in death/brain damage. In evaluating data from the Closed Project, it is important to t only litigated malpractice claims are in the database; therefore, failed t resolved uneventfully are captured, and the rate of events in the population of tracheally undergoing general anesthesia

11、cannot be calculated.ubated The NAP4 study was defined by the following and unplanned ICU admis recovery from anesthesiadesigned to track only major airway complications as es: death, brain damage, need for surgical , and 38 t occurred at emergence or were reported. This correspondsThe NAP4 study wa

12、s defined by the following and unplanned ICU admis recovery from anesthesiadesigned to track only major airway complications as es: death, brain damage, need for surgical , and 38 t occurred at emergence or were reported. This corresponds to a rate of complications of about 0.001% based on an estima

13、ted denominator of general anesthetics performed he United Kingdom (1 major airway textubation in 75,600 his group of 38 patients whose common comorbidities were obesity (46%), chronic obstructive pulmonary disease (34%), and obstructivesleep apnea(OSA; 13%), the mortality ratewas5% (2and the cumula

14、tive rate of nd severe morbidity (including ed arrestand braindamage) wasThe percentages of es from the ASA Closed Claims database the NAP4 are not ecause of the different nature of the data (closed versus tary report), but in both studies, reviewers considered frequently to be secondary to n approp

15、riate care” and/or judgment (often the presence of head and neck pathologies or handoffcommunications,andtolackofadequatetsurgical changes), to toperativemonitoring.Overall, these data t failure in the setting is rare, lly after elective surgery, but it is ted with escomplications occurring in other

16、 phases obstruction is the main cause of extubation failure and need for tracheal after anesthesia. Theseserious adverse events aredue to a combination tobstructivesurgery-related(head and neck surgery and upperairway manipulation) and, more plete management, and Keyword:ubation,Airwayobstruction,anesthesia, airway ，再插管率在 0.1和 0.451 小時，24 小時后的很少看到。很少的數據表明。199