• Richard H Epstein, Franklin Dexter, Iahn Cajigas, Anil K Mahavadi, Ashish H Shah, Nathalie Abitbol, and Ricardo J Komotar.
• Department of Anesthesiology, Pain Management and Perioperative Medicine, University of Miami, 1400 NW 12th Avenue, Suite 3075, Miami, FL 33136, United States of America. Electronic address: repstein@med.miami.edu.
• J Clin Anesth. 2020 Mar 1; 60: 118-124.

Study ObjectiveWe 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.DesignHistorical observational study.SettingNeurosurgical operating room suite in an academic teaching hospital.Patients294 patients undergoing elective supratentorial glioma surgery between 2012 and 2017 by a single neurosurgeon.Measurements1) 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 ResultsAnesthesia 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.ConclusionsLack of familiarity between the anesthesia provider and neurosurgeon during previous anesthetics is associated with prolonged tracheal extubation following intracranial glioblastoma surgery.Copyright © 2019 Elsevier Inc. All rights reserved.

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