ORIGINAL ARTICLES  ANESTHESIOLOGY Free access

Minerva Anestesiologica 1999 March;65(3):87-93

Copyright © 1999 EDIZIONI MINERVA MEDICA

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.