Neonatal intensive care unit patients recovering in the post anesthesia care unit: An observational analysis of postextubation complications.

Abstract

Neonatal patients are at higher risk in the perioperative period than older infants and children. Extubation as an early goal for noenatal intensive careunitpatients presenting for surgery is undergoing a renaissance period, and an exploration of adverse events following selection for extubation immediately after general anesthesia has not specifically been undertaken in this population. The objective of this study is to determine the adverse events most commonly encountered in neonatal intensive care unitpatients recovering from anesthesia in the post anesthesia care unit, quantify the risk of event occurrence, and identify risk factors that may increase the risk of postoperative adverse events. All neonatal intensive care unitpatients presenting to the operating room6/1/2014-5/31/2018 who recovered in thepost anesthesia care unit were included for analysis. Univariate analyses were conducted utilizing the Wilcoxon rank-sum test or Fisher exact test. Due to the low event rate, a small-sample generalized estimating equation model was created with a major event composite as the outcome and explanatory variables with P values<.1 on univariate analysis. Statistically significant continuous variables were then dichotomized based on Youden index. There were 707 operative cases in 607 patients. There were 81 total events recorded, and 64/81 were considered to be major events; all of which were respiratory. The risk of any postoperative event was 11.5%, major respiratory event requiring intervention by a nurse or provider was 9.1%, and reintubation was 0.8%. Birth weight<1.58kg (OR 3.71; 95% CI 2.11-6.53; P<.001) and postmenstrual age at surgery <41weeks (OR 3.20; 95% CI 1.54-6.63; P<.001) were strongly associated with an increased risk of a major postoperative respiratory event. The most important factors associated with major events in the post anesthesia care unitfollowing extubation of neonatal intensive care unitpatients were birth weight<1.58kg and postmenstrual age at surgery<41weeks. A patient with both features has a 7-fold increase in the odds of a major respiratory event in the post anesthesia care unit. Careful consideration of the postoperative ventilation and monitoring strategy must be given to patients with low birth weight (<1.58kg) or who are <41weeks postmenstrual age at the time of surgery.