Unplanned Intraoperative Extubations in Pediatric Neurosurgery: Analysis of Case Series to Increase Patient Safety.

Autor: Wagner KM; Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA., Raskin JS; Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA., Carling NP; Department of Pediatric Anesthesiology, Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA., Felberg MA; Department of Pediatric Anesthesiology, Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA., Kanjia MK; Department of Pediatric Anesthesiology, Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA., Pan IW; Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA., Luerssen TG; Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA., Lam S; Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA. Electronic address: sklam@texaschildrens.org.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2018 Jul; Vol. 115, pp. e1-e6. Date of Electronic Publication: 2017 Nov 03.
DOI: 10.1016/j.wneu.2017.10.149
Abstrakt: Objective: Unplanned intraoperative extubations (UIEs), rare but high-risk events. Unintentional extubations are used as quality improvement metrics in neonatal and pediatric intensive care units, but intraoperative events have received scant attention in the literature. Complexity of patient positioning and proximity of the operative field to anesthesia make neurosurgical procedures unique. UIEs prolong operative time, increase risk of adverse outcomes, including cardiopulmonary collapse, and potentially require additional procedures. Investigating each event is critical to prevention. We aimed to analyze occurrences of UIEs in the pediatric population.
Methods: We retrospectively reviewed UIE cases (12/2014-4/2017) in pediatric neurosurgical patients at a metropolitan pediatric Level I trauma center. Data were collected on patient demographics, procedure, operating room events before the event, and patient outcomes.
Results: Over 27 months, 5 UIEs in pediatric neurosurgical cases occurred, with an event rate of <0.3%. Two occurred in patients <1 year old. Two UIEs occurred in patients undergoing surgery for epilepsy. Root cause analysis identified varied etiologies of UIE: 2 were attributed to endotracheal tube securement, 2 were attributed to lighter anesthesia planes in epilepsy cases with limb movement, and 1 occurred while supinating a prone patient. Postoperative outcomes for these patients were no different from routine cases.
Conclusions: Findings suggest an inverse correlation between patient age and UIE, with patient manipulation and anesthesia depth as risk factors. Meticulous attention to securing the endotracheal tube and streamlined communication between the surgical and anesthesia teams are critical for the goal of zero UIE occurrences.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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