The study was carried out at the neurosurgical operating theater and neurosurgical intensive care unit, Maharaj Nakorn Chiang Mai University-Hospital. The study design was a retrospective Cohort study, recruited elective adult neurosurgical patients during December 1, 2021 to December 31, 2022. The patients were excluded if they had pre-operative definite airway control. The primary outcome was extubation success in the operating theater. Prolonged mechanical ventilation (PMV) means the patients who could not undergo the weaning protocol and extubation in 48 hours of surgery. The secondary outcome was the features associated with the prolonged mechanical ventilation.

Extubation in operating theater after elective intracranial surgery is superlative. Early extubation strategy should be planned in preoperative period jointly with neurosurgical team. Any deviations from the plan should be identified, whether they originated from surgical aspects or anesthetic managements. The time-point for extubation in neurosurgical patients is more challenging compared to other non-brain surgeries. We identified some potential prognostic impacts to prolonged mechanical ventilation in elective neurosurgical patients.

The study was approved by the Institution Research Ethics Committee Panel 5, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. (ANE-2565-09317). The study was carried out at the neurosurgical operating theater and neurosurgical intensive care unit, Maharaj Nakorn Chiang Mai University-Hospital. The study design was a retrospective Cohort study, recruited elective adult neurosurgical patients during December 1, 2021 to December 31, 2022. The patients were excluded if they had pre-operative definite airway control. The primary outcome was extubation success in the operating theater. Prolonged mechanical ventilation (PMV) means the patients who could not undergo the weaning protocol and extubation in 48 hours of surgery. The secondary outcome was the features associated with the prolonged mechanical ventilation. For continuous data, we used the student's t-test. For categorical data, we used the Fisher's exact or Chi-square test. Univariate analysis and multiple logistic regression were used to identified the prognostic factors. P values < 0.05 indicated statistical significance.

Inclusion Criteria:

• adult neurosurgical patients
• undergo elective surgery

Exclusion Criteria:

• already intubation before neurosurgical procedures
• tracheostomy

The study was carried out at the neurosurgical operating theater and neurosurgical intensive care unit, Maharaj Nakorn Chiang Mai University-Hospital. The study design was a retrospective Cohort study, recruited elective adult neurosurgical patients during December 1, 2021 to December 31, 2022. The patients were excluded if they had pre-operative definite airway control such as intubation or tracheostomy.