Factors Contributing to Delayed Extubation After Cervical Spine Surgery in Siriraj Hospital
Authors: Pawinee Pangthipampai, M.D., Thitima Chinachoti, M.D., Pathom Halilamien, M.D., Thachawan Jirativanont, M.D.,Patchareya Nivatpumin, M.D., Suratsawadee Jalayanavin, M.D., Suwicha Limkitcharenporn, M.D.
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Background: Cervical spine surgery brings up great concerns about post-operative severe complications and morbidities.
Anesthesiologists should know contributing factors for the delayed extubation which includes patient factors, surgical factors,
and anesthetic factors.
Objective: To study the factors related to delayed extubation for the benefit of anesthetistsั future decision making and the
Methods: Case-controlled study in a retrospective fashion. Patients who undertook cervical spine surgery during 2002-2007
without previous intubation, tracheostomy, and ones with data available to be collected; were identified for the study. Data
included age, sex, BMI, ASA classification, smoking history, pre-operative neurological deficit, history of previous C-spine
surgery, steroid administration, number of cervical spine surgeries, upper cervical level including, surgical approach, instruments,
intubation technique, duration of the operation, total blood loss, and total fluid replacement. All 16 factors were studied and
analyzed for their relationship to extubation difficulty.
Results: Of all 140 patients identified in the study, 70 were patients with immediate extubation and 70 were patients with delayed
extubation. Factors that are statistically significant in delayed extubation are: advancing age >60 years, ASA classification
> class 2, pre-operative neurological deficit, surgery >2 levels of spines, duration of the operation >180 minutes, fiberoptic
intubation technique, total fluid administration >4,000 ml during surgery and total blood loss >250 ml. When analyzed with
multivariate analysis, factors that related to delayed extubation are advancing age >60 years (odds ratio 4.077, 95% CI 1.56210.641),
neurological deficit (odds ratio 5.719, 95% CI 1.312-24.927), surgery >2 levels of spines (odds ratio 4.108, 95% CI
1.672-10.095), duration of operation >180 minutes (odds ratio 4.538, 95% CI 1.687-12.205), and fiberoptic intubation technique
(odds ratio 4.131, 95% CI 1.636-10.433).
Conclusion: There are 5 contributively factors that are related to delayed extubation in patients receiving cervical spine surgery at
Siriraj Hospital: advancing age >60 years, neurological deficit, surgery >2 levels of cervical spines, duration of the operation
>180 minutes, and fiberoptic intubation technique.