Early tracheal extubation after liver transplantation.
OBJECTIVE
To assess the value and safety of tracheal extubation in the operating room at the end of liver transplantation.


METHODS
Retrospective chart review.


METHODS
University Medical Center.


METHODS
Eighteen adult patients extubated in the operating room at the end of liver transplantation (study patients) compared with 17 patients who were not extubated and had < or = 3 U of blood transfused during liver transplantation (control patients).


METHODS
Data collected include severity of preoperative liver disease, anesthetic technique, use of venovenous bypass, surgical time, intraoperative blood replacement, core temperature and arterial blood gases on admission to the intensive care unit (ICU), times to discharge from ICU and the hospital.


RESULTS
Except for age (43.9 +/- 2.7 in study patients v 52.4 +/- 2.5 years; p = 0.03), patients were similar with regard to preoperative Child's-Pugh class and liver function tests. Study patients received more crystalloid in the OR (5,306 +/- 561 v 3,771 +/- 454 mL; p = 0.04), were warmer (36.6 degrees C +/- 0.2 degree C v 35.6 degrees C +/- 0.3 degree C; p = 0.01), had a lower arterial pH (7.29 +/- 0.01 v 7.36 +/- 0.02; p = 0.003) and higher arterial carbon dioxide tension (45 +/- 1 v 35 +/- 2 mmHg; p < 0.001) on admission to ICU than controls. There were no significant differences between groups with regard to discharge times from the ICU (50.6 +/- 2.7 hours in the study group v 61.2 +/- 4.7 in control group; p = 0.06), or discharge from the hospital (14.8 +/- 1.6 in the study group v 21.3 +/- 3 days in control group; p = 0.06).


CONCLUSIONS
Tracheal extubation of selected patients at the end of liver transplant surgery in the operating room is safe but did not result in decreased ICU or hospital stay.
Neelakanta
G
G
Department of Anesthesiology, UCLA Medical Center 90095-1778, USA.
Sopher
M
M
Chan
S
S
Pregler
J
J
Steadman
R
R
Braunfeld
M
M
Csete
M
M
D000328:Adult; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies