Criteria for immediate postoperative extubation in adult recipients following living-related liver transplantation with total intravenous anesthesia

Cammu, Guy; Decruyenaere, Johan; Troisi, Roberto; Hemptinne, Bernard de; Colardyn, Francis; Mortier, Éric

doi:10.1016/j.jclinane.2003.02.008

Cited by 38 publications

(26 citation statements)

References 19 publications

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“…They used fewer units of blood during surgery and demonstrated good graft function. Other investigators have confirmed the good predictive power of these characteristics [13,33 ]. Patients with these characteristics were then recruited into prospective IPE trials.…”

Section: Evidence For Use Of Immediate Postoperative Extubation In LImentioning

confidence: 87%

“…The single principal factor consistently reported by most study sites is the preoperative presence of encephalopathy due to chronic or acute liver failure [13,14,16]. Other variables such as blood loss, renal replacement and severity of illness are highly inconsistent between study sites.…”

Section: Variables That Affect Immediate Postoperative Extubation Outmentioning

confidence: 99%

“…These include aortic valve surgery [9], other types of cardiac surgery requiring sternotomy [10], complex vascular reconstruction [11] and esophagectomy [12]. The evidence from these studies clearly shows that the size of the surgical procedure is not an independent predictor of postoperative respiratory failure and therefore should not play a major role in extubation decisions, including liver transplantation [13].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The clinical value of early extubation

Mandell¹,

Campsen

Zimmerman

et al. 2009

Current Opinion in Organ Transplantation

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There is robust evidence to support the use of immediate postoperative ventilation in liver transplant recipients. There is no evidence, however, to show that routine ventilation of all transplant recipients provides outcomes that are as good as those documented in extubated patients. It is probably time to turn the evidentiary tables around and ask proponents of routine ventilation to prove that they have done no harm and that they meet the new minimal performance standards established by immediate postoperative extubation.

show abstract

Section: Evidence For Use Of Immediate Postoperative Extubation In LImentioning

confidence: 87%

Section: Variables That Affect Immediate Postoperative Extubation Outmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The clinical value of early extubation

Mandell¹,

Campsen

Zimmerman

et al. 2009

Current Opinion in Organ Transplantation

View full text Add to dashboard Cite

show abstract

“…This approach was associated to be safe for the recipient, without any increased incidence for reintubation [13,14,23], and is applicable for both the pediatric liver transplantation as well as the living-related liver donation [12,16,24]. Further advantage is the reduction in the costs due to the decreased utilization of intensive capacities, which are noted in an American study to be approximately 13% of the total costs of a liver transplantation [25].…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, in numerous transplant centers the extubation time-However, in spite of all these advantages not all patients profit from the fast tracking concept. The rate of extubation in the operating theatre is currently approximately 80%, which implies that still about one fifth of all patients in intensive care unit receive artificial ventilation [5,8,12,[14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Failure of Immediate Tracheal Extubation After Liver Transplantation - A Single Center Experience

Hoffmeister¹,

Stange²,

Neumann³

et al. 2008

TOSJ

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Fast tracking approaches in liver transplantation include postoperative extubation immediately after surgery in the operating theatre. Based on the experience of 837 liver transplantations performed between 01/97 and 05/05, we report on the safety and feasibility of this procedure in almost 80% of transplant recipients, without increasing the incidence of subsequent reintubation (11%). This patient population experienced significantly higher survival compared to patients in whom extubation succeeded at the intensive care unit (p<0.02). Special attention was required for recipients with acute liver failure or retransplantation. These patients did not participate in fast tracking protocols, as demonstrated by a multivariate regression analysis. In this context, failure of immediate tracheal extubation was independent of cold ischemic time, duration of surgery, donor / recipient age or gender, extent of preservation injury, or type of organ donation (postmortal vs living-related). ROC analysis revealed that only intraoperative transfusions of 6 units of red blood cells were associated with primary extubation in the operating theatre with high sensitivity and specifity. To conclude, postoperative mechanical ventilation is justified only in a small cohort of recipients. For the vast majority of patients, immediate postoperative tracheal extubation should be the standard procedure after liver transplantation.

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The effects of desflurane and propofol-remifentanil on postoperative hepatic and renal functions after right hepatectomy in liver donors

Gwak

Choi

et al. 2008

Liver Transpl

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Various volatile anesthetics have been used in hepatectomy in living donors, and their effects on major organs have been extensively evaluated. However, the impact of total intravenous anesthesia (TIVA) on postoperative liver and renal functions after large liver resections has been less extensively investigated than that of volatile agents. The aim of this study was to compare the postoperative hepatic and renal functions between volatile anesthesia with desflurane and TIVA with propofolremifentanil in living donors undergoing right hepatectomy. Seventy adult patients were randomly allocated into 2 groups: the desflurane group (n ϭ 35) and TIVA group (n ϭ 35). Aspartate aminotransferase, alanine aminotransferase, prothrombin time (PT), albumin, total bilirubin (TB), blood urea nitrogen (BUN), creatinine (Cr), BUN/Cr ratio, estimated glomerular filtration rate (GFR), platelet count, and hemoglobin levels were analyzed in the preoperative period, immediately after the operation, and on the first, second, third, fifth, seventh, and thirtieth postoperative days (PODs). Most of the liver function test results were not significantly different between the 2 groups. However, PT (international normalized ratio) and TB were significantly greater on POD 5 in the TIVA group. Among the renal function tests, Cr was significantly higher and estimated GFR was significantly lower on POD 1 in the TIVA group. The platelet counts and hemoglobin levels were similar between the 2 groups. In conclusion, the results of our study suggest that living related donors for liver transplant may have a better outcome following anesthesia with desflurane. However, further testing will be necessary to prove this hypothesis.

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Criteria for immediate postoperative extubation in adult recipients following living-related liver transplantation with total intravenous anesthesia

Cited by 38 publications

References 19 publications

The clinical value of early extubation

The clinical value of early extubation

Failure of Immediate Tracheal Extubation After Liver Transplantation - A Single Center Experience

The effects of desflurane and propofol-remifentanil on postoperative hepatic and renal functions after right hepatectomy in liver donors

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