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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
ORIGINAL ARTICLES ANESTHESIOLOGY
Minerva Anestesiologica 1999 March;65(3):87-93
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.