Prolonged tracheal extubation time after glioma surgery was associated with lack of familiarity between the anesthesia provider and the operating neurosurgeon. A retrospective, observational study

Richard H. Epstein, Franklin Dexter, Iahn Cajigas, Anil K. Mahavadi, Ashish H. Shah, Nathalie Abitbol, Ricardo J. Komotar

Research output: Contribution to journalArticle

Abstract

Study objective: We consider the effect of the number of previous interactions between the anesthesia provider and a single neurosurgeon during neurosurgical procedures (“familiarity”) and occurrence of an interval ≥15 min from the end of surgery (i.e., dressings applied) to tracheal extubation (“prolonged extubation”) during subsequent glioma procedures by that neurosurgeon. The value of 15min is a threshold at which post-case activity by non-anesthesia personnel in the operating room ends. Design: Historical observational study. Setting: Neurosurgical operating room suite in an academic teaching hospital. Patients: 294 patients undergoing elective supratentorial glioma surgery between 2012 and 2017 by a single neurosurgeon. Measurements: 1) Time from end of surgery (“dressings applied”) to extubation; 2) number of previous cases where the anesthesia provider had been present at the end of a neurosurgical procedure performed by the neurosurgeon; 3) case duration. Main results: Anesthesia providers (nurse anesthetists or anesthesia residents) were considered “unfamiliar” with the neurosurgeon if they had been present at the time of extubation for <5 previous neurosurgical cases (including glioma and non-glioma surgery) performed by the neurosurgeon during the study interval. For approximately half the cases the anesthesia provider was unfamiliar with the neurosurgeon. There was an association between the provider's number of historical cases with the neurosurgeon and prolonged extubation (P = 0.0048); the adjusted odds ratio (by unadjusted logistic regression) for unfamiliarity was 2.10 (95% CI 1.28 to 3.44, P = 0.025). Consistent with previously shown associations between case duration and prolonged extubation, analyses were valid based on a near-linear relationship between the logit (prevalence of prolonged extubation) and the case duration quintile. Conclusions: Lack of familiarity between the anesthesia provider and neurosurgeon during previous anesthetics is associated with prolonged tracheal extubation following intracranial glioblastoma surgery.

Original languageEnglish (US)
Pages (from-to)118-124
Number of pages7
JournalJournal of Clinical Anesthesia
Volume60
DOIs
StatePublished - Mar 2020

Fingerprint

Airway Extubation
Glioma
Observational Studies
Anesthesia
Retrospective Studies
Logistic Models
Neurosurgical Procedures
Operating Rooms
Bandages
Nurse Anesthetists
Recognition (Psychology)
Neurosurgeons
Glioblastoma
Teaching Hospitals
Anesthetics
Odds Ratio

Keywords

  • Airway extubation
  • Anesthesia
  • Glioma
  • Logistic models

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Prolonged tracheal extubation time after glioma surgery was associated with lack of familiarity between the anesthesia provider and the operating neurosurgeon. A retrospective, observational study. / Epstein, Richard H.; Dexter, Franklin; Cajigas, Iahn; Mahavadi, Anil K.; Shah, Ashish H.; Abitbol, Nathalie; Komotar, Ricardo J.

In: Journal of Clinical Anesthesia, Vol. 60, 03.2020, p. 118-124.

Research output: Contribution to journalArticle

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abstract = "Study objective: We consider the effect of the number of previous interactions between the anesthesia provider and a single neurosurgeon during neurosurgical procedures (“familiarity”) and occurrence of an interval ≥15 min from the end of surgery (i.e., dressings applied) to tracheal extubation (“prolonged extubation”) during subsequent glioma procedures by that neurosurgeon. The value of 15min is a threshold at which post-case activity by non-anesthesia personnel in the operating room ends. Design: Historical observational study. Setting: Neurosurgical operating room suite in an academic teaching hospital. Patients: 294 patients undergoing elective supratentorial glioma surgery between 2012 and 2017 by a single neurosurgeon. Measurements: 1) Time from end of surgery (“dressings applied”) to extubation; 2) number of previous cases where the anesthesia provider had been present at the end of a neurosurgical procedure performed by the neurosurgeon; 3) case duration. Main results: Anesthesia providers (nurse anesthetists or anesthesia residents) were considered “unfamiliar” with the neurosurgeon if they had been present at the time of extubation for <5 previous neurosurgical cases (including glioma and non-glioma surgery) performed by the neurosurgeon during the study interval. For approximately half the cases the anesthesia provider was unfamiliar with the neurosurgeon. There was an association between the provider's number of historical cases with the neurosurgeon and prolonged extubation (P = 0.0048); the adjusted odds ratio (by unadjusted logistic regression) for unfamiliarity was 2.10 (95{\%} CI 1.28 to 3.44, P = 0.025). Consistent with previously shown associations between case duration and prolonged extubation, analyses were valid based on a near-linear relationship between the logit (prevalence of prolonged extubation) and the case duration quintile. Conclusions: Lack of familiarity between the anesthesia provider and neurosurgeon during previous anesthetics is associated with prolonged tracheal extubation following intracranial glioblastoma surgery.",
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AU - Dexter, Franklin

AU - Cajigas, Iahn

AU - Mahavadi, Anil K.

AU - Shah, Ashish H.

AU - Abitbol, Nathalie

AU - Komotar, Ricardo J.

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KW - Glioma

KW - Logistic models

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