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Copyright ©The Author(s) 2015.
World J Hepatol. Sep 18, 2015; 7(20): 2303-2308
Published online Sep 18, 2015. doi: 10.4254/wjh.v7.i20.2303
Table 1 Early extubation in adult liver transplant recipients
Ref.Patients (n)AnesthesiaCriteria for extubationFindings
Rossaint et al[5]5/39Fentanyl infusion, methohexital infusion, thiopental, pancuronium"According to established criteria" but not clearly delineated
Mandell et al[3]University of Colorado: 16/67 early extubation; UCSF: 25/106 early extubationThiopental, succinylcholine, isoflurane or desflurane, fentanyl, lorazepam, doxacuriumPreoperative: UNOS status 3 or 4; No coexistent disease; Age < 50 yr; No Encephalopathy; Intraoperative: Good donor liver function; < 10 units of red blood cells administered; No vasoactive support at end of surgery; A-a gradient < 150 mmHgUniversity of Colorado: 0/16 reintubations; UCSF: 2/25 reintubations (hypoventilation/respiratory failure)
Neelakanta et al[7]35 total patients: 18 extubated in OR; 17 extubated in ICUMidazolam, thiopental, succinylcholine, isoflurane, fentanyl, morphine, pancuroniumGood nutritional status, no significant cardiac or pulmonary disease, uneventful surgical course, < 3 units of red blood cells transfused, sign of early graft function, normothermia. Decision was made by anesthesiologist after consultation with surgeonO reintubations for either group. No difference in ICU length of stay; Immediate extubation group had more respiratory acidosis on admission to ICU
Biancofiore et al[1]365 total patients: Group A: 211 extubated in OR; Group B: 113 extubated < 24 h; Group C: 41 extubated > 24 hFentanyl, thiopental, cisatracurium, sevoflurane, remifentanilAwake, following commands, clinical evidence of neuromuscular reversal, normocarbia, respiratory rate < 25, adequate oxygenation (pulse oximetry > 95% with FiO2 < 0.5), hemodynamic stabilityGroup A: 2/211 reintubations (surgical bleeding, pneumonia); Group C: 4/41 reintubations (surgical bleeding, pneumonia, hepatic artery thrombosis). Non-invasive ventilation performed in 11/211 Group A and 6/113 in Group B
Glanemann et al[9]546 total patients: Group 1: 102 extubated in OR; Group 2: 383 extubated < 24 h; Group 3: 61 extubated > 24 hFentanyl, methohexital, pancuroniumHemodynamic stability, normothermia, tidal volume of 5-8 mL/kg, respiratory rate < 20/min, adequate minute ventilation, positive gag reflex, awake and responsiveGroup 1: 9/102 reintubated; Group 2: 50/383 reintubated; Group 3: 22/61 reintubated; Survival at 5 yr greatly reduced in Group 3 and in patients whom underwent reintubation. Liver graft reperfusion injury significantly influenced success and time to extubation
Skurzak et al[10]652 total patients: 575 extubation in OR; 77 nonextubated patientsVaried: Isoflurane or sevoflurane, fentanyl, remifentanil, sufentanil, pancuronim, atracurium, cis-atracurium. Extubated in ORConventional criteria used to determine for extubation. Contraindications to early extubation: active bleeding with a need for abdominal packing, preoperative mechanical ventilation, grade 4 encephalopathy, graft dysfunction (acidosis, persistent coagulopathy, hemodynamic instability)30/575 reintubations within 48 h (surgical interventions, oversedation, pulmonary failure, pulmonary edema, cerebral ischemia, hepatic/renal failure)
Mandell et al[2]147 total patients: 111 extubated in OR; 23 no attempt at extubation; 13 failed to meet extubation criteriaThiopental, succinylcholine, isoflurane or desflurane, fentanyl, lorazepam, doxacuriumAwake, following commands, positive gag reflex, tidal volumes > 8 mL/kg, respiratory rate < 20/min, normocarbia, adequate neuromuscular reversal, hemodynamic stability2/111 reintubations within 48 (portal vein thrombosis, oversedation)