Successful extubation in the operating room after infratentorial craniotomy: The Cleveland Clinic experience

Background: There is lack of information in the literature about the rate of successful extubation after infratentorial craniotomy and the risk factors associated with failed extubation. This retrospective analysis assessed the rate of successful extubation after infratentorial craniotomy in a tertiary hospital. Methods: Only infratentorial craniotomies for tumors, vascular malformations in the brainstem or cerebellum, and fourth ventricle cysts performed in prone position were included. Failed extubation was defined as the need for airway reintubation in the operating room (OR), postanesthesia care unit, or intensive care unit after surgery. Only those patients, in whom the primary reason for reintubation was respiratory failure, deteriorating level of consciousness, or inability to protect the airway were included in the statistical analysis. Prolonged intubation was defined as airway intubation longer than 48 hours from the initial intubation. Results: This is a retrospective study that included perioperative information from 145 adult patients. One hundred and twenty patients (82%) were primarily extubated in the OR and the rest remained intubated (18%). From the latter group, 9 (36%) and 16 (64%) were extubated in the postanesthesia care unit or intensive care unit, respectively. The rate of failed extubation within 24 hours after primary extubation in the OR was 0.83%. Patients not extubated in the OR had a statistically significant higher American Society of Anesthesiologists score, a longer length of surgery, a larger blood loss, and a longer stay in the hospital compared with those who were extubated in the OR. Conclusions: We conclude that primary extubation in the OR after infratentorial craniotomy is feasible. However, cautions should be taken in patients with poor physical status undergoing vascular surgery and long procedures with potential significant fluid shifts.