title: Fast track anesthesia for liver transplantation reduces postoperative ventilation time but not intensive care unit stay.
abstract: Fast tracking is an approach to health care delivery that emphasizes the efficient use of resources. This investigation was designed to determine whether shorter-acting drugs and different drug administration practices reduce the length of time for which patients require mechanical ventilation and intensive care after liver transplantation. After obtaining Institutional Review Board approval and informed consent, we randomized 80 consecutive patients (>17 years) undergoing liver transplantation to receive either our traditional anesthetic (thiopental, pancuronium, 50 microg/kg fentanyl), or fast track anesthetic (propofol, cisatracurium, 20 microg/kg fentanyl). The patients were weaned to extubation in the intensive care unit after an established clinical protocol. Measured data included the occurrence of intraoperative hypotension, intraoperative hypertension, intraoperative tachycardia, the length of postoperative mechanical ventilation, length of intensive care unit stay, and episodes of reintubation. Seventy-eight patients remained in the study through the investigation (two died intraoperatively). Operating time; amount of intraoperative red blood cells transfused; lowest body temperature achieved; and minutes of intraoperative hypotension, hypertension, and tachycardia were not different between the traditional and fast track patient groups. Postoperative ventilation time was greater in the patients who received the traditional anesthetic; mean. 1,081 minutes (median, 855) versus mean, 553.5 minutes (median, 390) (P <.001). However, there was no difference in length of intensive care unit stay. Five patients required reintubation (two patients given the traditional anesthetic, three given the fast track anesthetic). We conclude that a fast track approach to anesthetic care reduces the requirement for postoperative mechanical ventilation, but does not reduce intensive care unit stay after liver transplantation.
authors.affiliation: Department of Anesthesiology and Critical Care, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: James Y
authors.initials: JY
authors.lastname: Findlay
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Jankowski
authors.forename: Gurinder M
authors.initials: GM
authors.lastname: Vasdev
authors.forename: Robert C
authors.initials: RC
authors.lastname: Chantigian
authors.forename: Bhargavi
authors.initials: B
authors.lastname: Gali
authors.forename: Gerard S
authors.initials: GS
authors.lastname: Kamath
authors.forename: Mark T
authors.initials: MT
authors.lastname: Keegan
authors.forename: Brian A
authors.initials: BA
authors.lastname: Hall
authors.forename: Keith A
authors.initials: KA
authors.lastname: Jones
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Burkle
authors.forename: David J
authors.initials: DJ
authors.lastname: Plevak
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007431:Intraoperative Complications / Q000453:epidemiology; D007902:Length of Stay; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011182:Postoperative Care; D012121:Respiration, Artificial; D013997:Time Factors