The care of pediatric liver transplant recipients has traditionally included postoperative mechanical ventilation. In 2005, we started extubating children undergoing liver transplantation in the operating room according to standard criteria for extubation used for general surgery cases. We reviewed our single-center experience to determine our rates of immediate extubation and practice since that time. The records of 84 children who underwent liver transplantation from 2005 to 2011 were retrospectively reviewed. The immediate extubation rate increased from 33% during 2005-2008 to 67% during 2009-2011. Immediate extubation did not result in an increased reintubation rate in comparison with delayed extubation in the intensive care unit (ICU). Patients undergoing immediate extubation had a trend toward a shorter mean ICU stay as well as a significantly decreased overall hospital length of stay. Our findings suggest that there is a learning curve for instituting immediate extubation in the operating room after liver transplantation and that the majority of pediatric liver recipients can safely undergo immediate extubation. Liver Transpl 21:57-62, 2015. V C 2014 AASLD.Received December 5, 2013; accepted September 14, 2014.In 1997, studies reported an increasing frequency of immediate extubation of adult liver transplant recipients in the operating room. 1,2 Subsequent studies showed no increase in reintubation rates, decreased postoperative days in the intensive care unit (ICU), and decreased associated costs with immediate extubation. 2 Despite this increase in the fast-tracking of adult liver transplant recipients, common management in pediatric liver transplantation has continued to include postoperative ventilation. 3 A recently presented abstract examining the Studies of Pediatric Liver Transplantation database demonstrated that among the 25 centers queried, those centers with an overall shorter hospital stay and lower costs had a shorter duration of postoperative intubation (2.7 days) in comparison with other centers (6.5 days). The authors concluded that early extubation may result in a decreased length of stay. 4 In 2005, we began immediately extubating pediatric liver transplant recipients if all team members were comfortable with that plan. The current study sought to (1) examine our rates of immediate extubation, (2) identify factors associated with immediate extubation or postoperative ventilation, and (3) evaluate postoperative outcomes after this practice change. PATIENTS AND METHODSApproval for the study and a waiver for consent were obtained from the institutional review board. We performed a retrospective review of the medical records of all pediatric liver transplant recipients from January 2005 through December 2011 at our institution. Patients with preoperative ventilator requirements were subsequently excluded from the analysis. Three patients were included in the data set twice for Abbreviations: BMI, body mass index; ICU, intensive care unit; MELD, Model for End-Stage Liver Disease; PELD, Pedia...

Even in young infants, radiographic determination of the catheter tip appears warranted when thoracic catheters are placed via the caudal route.

Case-mix explained most associations between higher risk of pediatric ARCA and anesthesiologist-related variables at our institution, but the association with fewer annual days delivering anesthetics remained. Our findings highlight the need for rigorous adjustment for patient risk factors in anesthesia patient safety studies.

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Increased catecholamine secretion from neuroblastomas can occasionally be demonstrated, but severe hypertension is uncommon. We report the perioperative management of a 5 year old child with stage III adrenal neuroblastoma who presented with malignant hypertension and high norepinephrine and dopamine levels. Hypertensive crises occurred during anesthesia for surgical biopsy and during chemotherapy. After blood pressure control using phenoxybenzamine and enalapril, doxazosin was used successfully as the preoperative alpha-adrenergic receptor antagonist for surgical tumor resection.

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