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The tracheal reintubation of a surgical patient in the postanesthesia care unit (PACU) is a critical event that increases patient morbidity and mortality, cost, and staff demands. We performed a descriptive retrospective cohort study to identify the incidence of reintubation after planned extubation (RAP) in the PACU from 2010 to 2017. The incidence of RAP was 0.00083% (89/107,845) for the entire study period, an incidence range from 0.00014% to 0.00172% (1/7,407 to 26/15,139) with a steady decline from 2011 to 2017. A post hoc application of published prediction tools demonstrated that most RAP cases could be predicted preoperatively when the RAP predictive risk index (described in 2013) was applied to patients over the age of 64 years. Preoperative attention to increased risk of RAP decreases the incidence of RAP. Neuromuscular blockade (NMB) must be monitored, and reversal must be ensured. Attempting to reverse moderate to deep NMB with increased dosing of neostigmine should be avoided, and NMB reversal with sugammadex should be used in these cases and when residual weakness is observed. Hypothermia must be avoided, and a multimodal pain management regimen must be adopted. [ABSTRACT FROM AUTHOR]

Aims and objectives. To investigate and synthesise published literature on the associations between residual neuromuscular blockade and critical respiratory events of postoperative adult patients in the postanaesthesia care unit. Background. Residual neuromuscular blockade continues to be common among patients transferred to the postanaesthesia care unit after general anaesthesia, while negative effects of residual neuromuscular blockade on respiratory function have been demonstrated in laboratory volunteers. Design. Literature review. Methods. Using key terms, a search was conducted in Cumulative Index for Nursing and Allied Health Literature, PubMed, Web of Science, Cochrane Database and EMBASE (January 1990-May 2013) for clinical trials or observational studies on the associations between residual neuromuscular blockade and critical respiratory events, published in English-language journals. Results. Nine articles met the inclusion criteria. Residual neuromuscular blockade definition threshold differed between studies. Among critical respiratory events, only hypoxaemia was investigated in all included studies. Residual neuromuscular blockade was significantly associated with increased incidence of hypoxaemia during postanaesthesia care unit stay in most studies, while associations with the rest of the critical respiratory events were inconclusive. Conclusions. Although limited, existing research has provided evidence that patients with residual neuromuscular blockade are at high risk of early postoperative hypoxaemia. Further studies are needed to investigate independent associations between residual neuromuscular blockade and critical respiratory events, along with causality of these associations. The clinical importance of residual neuromuscular blockade for groups at high risk of critical respiratory events should also be investigated. Relevance to clinical practice. Healthcare professionals have to be aware of the increased risk of hypoxaemia in patients with residual neuromuscular blockade. Efforts to decrease residual neuromuscular blockade incidence, combined with identification and appropriate evaluation of patients with residual neuromuscular blockade during postanaesthesia care unit stay, are recommended. [ABSTRACT FROM AUTHOR]