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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 1999 March;65(3):87-93

language: Italian

Early tra­cheal extu­ba­tion ­after ­liver trans­plan­ta­tion

Biancofiore G. 1, Bindi M. L. 1, Cellai F. 1, Consani G. 1, Sansevero A. 1, Amorese G. 1, Filipponi F. 2, Vistoli F. 2, Mosca F. 2, Vagelli A. 1

1 Azienda Ospedaliera Pisana, Policlinico di Cisanello - Pisa, 1a UO Anestesia e Rianimazione, UTI Postchirurgica e Trapianti;
2 Università degli Studi - Pisa, UO Chirurgia Generale e Vascolare


Back­ground. To eval­uate an ­early tra­cheal extu­ba­tion fea­sibility in pre­vi­ously unse­lected ortho­topic ­liver trans­plan­ta­tion (OLT) ­patients.
­Methods. ­Design: ret­ro­spec­tive anal­ysis. Set­ting: ­National ­Health ­System Inten­sive ­Care ­Unit. ­Patients: all the ­patients who under­went OLT ­during 1997 at our insti­tu­tion ­were eval­u­ated. The anes­the­stic man­age­ment was the ­same for all of ­them and a ­veno-­venous ­bypass was ­always ­used ­during the anhe­patic ­phase. Tra­cheal extu­ba­tion was per­formed ­when meta­bolic and hae­mod­y­namic param­e­teres ­were ­stable; the fol­lowing extu­ba­tion cri­teria ­were ­also con­sid­ered: no ­residual cur­ar­iza­tion, nor­mo­carbia, ­ability to ­keep the ­airway ­patent, ­good res­pir­a­tory ­drive, ­ability to ­carry out ­simple ­orders. No pre- or intra­op­er­a­tive cri­teria, as pre­vi­ously ­reported in the lit­er­a­ture for OLT ­patients, ­were fol­lowed to per­form tra­cheal extu­ba­tion in the post­op­er­a­tive ­period.
­Results. ­During 1997 ­forty ­OLTs ­were ­perfor-med in 38 ­patients. ­Twenty-­eight ­patients ­were suc­cess­fully extu­bated ­within 3 ­hours ­from the end of the sur­gical pro­ce­dure; ­three ­patients ­were extu­bated ­within 6 ­hours and ­three ­ ­within 24 ­hours ­from the end of sur­gery; ­four ­patients ­needed ­more ­then 24 ­hours of ven­ti­la­tion or ­were impos­sible to ­wean. No ­patient was re-intu­bated. A cor­re­la­tion ­appeared evi­dent ­between ­early extu­ba­tion and the ­amount of the trans­fused red ­cell ­units, kid­neys and ­lungs func­tion, car­di­o­vas­cular effi­ciency; no cor­re­la­tion ­emerged ­with ­patients age or the pre-trans­plant ­severity of the ­hepatic dis­ease.
Con­clu­sions. To per­form a ­safe ­early tra­cheal extu­ba­tion in pre­vi­ously unse­lected OLT ­patients is fea­sible and it can be car­ried out in a ­wide ­number of ­them. The pre­vi­ously ­reported ­timing char­ac­ter­izing as “­early” a tra­cheal extu­ba­tion ­should be ­moved ­from 8 to 3 ­hours.

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