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Fast track in liver transplantation: 5 years' experience

Published online by Cambridge University Press:  28 July 2005

G. Biancofiore ,
M. L. Bindi ,
A. M. Romanelli ,
A. Boldrini ,
M. Bisà ,
M. Esposito ,
L. Urbani ,
G. Catalano ,
F. Mosca  and
F. Filipponi
G. Biancofiore
Affiliation:
Cisanello Hospital, Postsurgical and Transplantation ICU, Department of Anaesthesia and Critical Care, Pisa, Italy
M. L. Bindi
Affiliation:
Cisanello Hospital, Postsurgical and Transplantation ICU, Department of Anaesthesia and Critical Care, Pisa, Italy
A. M. Romanelli
Affiliation:
National Research Council, Department of Biostatistics; University School of Medicine, Pisa, Italy
A. Boldrini
Affiliation:
Cisanello Hospital, Postsurgical and Transplantation ICU, Department of Anaesthesia and Critical Care, Pisa, Italy
M. Bisà
Affiliation:
Cisanello Hospital, Postsurgical and Transplantation ICU, Department of Anaesthesia and Critical Care, Pisa, Italy
M. Esposito
Affiliation:
Cisanello Hospital, Postsurgical and Transplantation ICU, Department of Anaesthesia and Critical Care, Pisa, Italy
L. Urbani
Affiliation:
Liver Transplant Unit, Pisa, Italy
G. Catalano
Affiliation:
Liver Transplant Unit, Pisa, Italy
F. Mosca
Affiliation:
General and Transplantation Surgery, Pisa, Italy
F. Filipponi
Affiliation:
Liver Transplant Unit, Pisa, Italy
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Extract

Summary

Background and objective: Reducing postoperative mechanical ventilation in patients undergoing liver transplantation may have clinical and organizational advantages. On the basis of our experience, we here evaluate the possibility of practising immediate tracheal extubation in the operating theatre. Methods: In this prospective study, patients consecutively undergoing liver transplantation between 1 June 1999 and 31 May 2004 were extubated in the operating theatre at the end of surgery on the basis of standardized and universally accepted criteria, under conditions of haemodynamic and metabolic stability. Results: Two hundred and seven of the 354 patients (58.5%) were extubated immediately after the completion of the surgical procedure (mean time between end of surgery and extubation: 0.4 ± 1.4 min); two were re-intubated. In the last of the 5 yr of the study, the percentage of immediate extubations increased to 82.5%. During the study period, there was a progressive increase in the number of immediate extubations per individual member of the team of anaesthetists. The pre-transplant Child-Pugh severity of the underlying liver disease did not predict rapid extubation, but the Model for End-stage Liver Disease score of <11 did (receiver operator characteristic area under the curve = 0.61; P < 0.05). Conclusions: Immediate extubation after liver transplantation is possible in a substantial percentage of cases; confidence, habit and a spirit of emulation are decisive factors in encouraging anaesthetists to extend this practice to the largest possible number of patients. A successful immediate extubation may be an important indicator of perioperative quality of care in liver transplantation.

Keywords

LIVER TRANSPLANTATIONANAESTHESIA GENERALINTUBATION, intratrachealVENTILATOR WEANING

Information

Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 8 , August 2005 , pp. 584 - 590
Copyright
© 2005 European Society of Anaesthesiology

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References

Consensus Conference on indications of liver transplantation. Hepatology 1994; 20: 1S–68S.
McDonald M, Perkins JD, Ralph D, Carithers RL. Postoperative care. In: Maddrey WC, Sorrel MF, eds. Transplantation of the Liver. Norwalk, USA: Appleton & Lange, 1995: 171–206.
Jullien T, Valtier B, Hongnat JM et al. Incidence of tricuspid regurgitation and vena caval backward flow in mechanically ventilated patients. A color Doppler and contrast echocardiographic study. Chest 1995; 107: 488–493.Google Scholar
Carton EG, Plevak DJ, Kranner PW et al. Perioperative care of the liver transplant patient: Part 2. Anesth Analg 1994; 78: 382–399.Google Scholar
Mandell MS, Lezotte D, Kam I, Zamudio S. Reduced use of intensive care after liver transplantation: influence of early extubation. Liver Tranpl 2002; 8: 676–681.Google Scholar
Biancofiore G, Romanelli A, Bindi ML et al. Very early tracheal extubation without predetermined criteria in a liver transplant recipient population. Liver Transpl 2001; 7: 777–782.Google Scholar
Deitch EA. Multiple organ failure; pathophysiology and potential future therapy. Ann Surg 1992; 216: 117–134.Google Scholar
Antonelli M, Conti G, Bufi M et al. Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA 2000; 283: 235–241.Google Scholar
Miller KA, Harkin CP, Bailey PL. Postoperative tracheal extubation. Anesth Analg 1995; 89: 149–172.Google Scholar
Siciliano D. Con: Early extubation is not preferable to late extubation in patients undergoing coronary artery surgery. J Cardiothor Vasc Anesth 1992; 6: 494–498.Google Scholar
Higgins JE. Pro: Early extubation is preferable to late extubation in patients undergoing coronary artery surgery. J Cardiothor Vasc Anesth 1992; 6: 488–493.Google Scholar
Ben-Haim SA, Amar R, Shofty R, Dinnar U. Low positive end expiratory pressures improve the left ventricular workload vs. coronary blood flow relationship. J Cardiovasc Surg 1991; 32: 239–245.Google Scholar
Roissant R, Slama K, Jaeger M et al. Fluid restriction and early extubation for successful liver transplantation. Transplant Proc 1990; 22: 1533–1534.Google Scholar
Kaisers U, Langrehr JM, Haack M et al. Hepatic venous catheterization in patients undergoing positive end-expiratory pressure ventilation after OLT: technique and clinical impact. Clin Transplant 1995; 9: 301–306.Google Scholar
Mandell MS, Lockrem J, Kelley SD. Immediate tracheal extubation after liver transplantation: experience of two transplant centers. Anesth Analg 1997; 84: 249–253.Google Scholar
Neelakanta G, Sopher M, Chan S et al. Early extubation after liver transplantation: early extubation is not preferable to late extubation in patients undergoing coronary artery surgery. J Cardiothor Vasc Anesth 1997; 11: 165–167.Google Scholar
Glanemann M, Langrehr J, Kaisers U et al. Postoperative tracheal extubation after orthotopic liver transplantation. Acta Anaesthesiol Scand 2001; 45: 333–339.Google Scholar
Findlay JY, Jankowski CJ, Vasdev G et al. Fast track anaesthesia for liver transplantation reduces postoperative ventilation time but not intensive care unit stay. Liver Transpl 2002; 8: 670–675.Google Scholar
Lindop M. We have a liver. Have we got a bed? Intensive care support for liver transplantation surgery. Liver Transpl 2002; 8: 688–689.Google Scholar