B Błaszczyk1, B Wrońska2, M Klukowski2, E Flakiewicz2, M Kołacz2, L Jureczko2, M Pacholczyk3, A Chmura3, J Trzebicki2. 1. I Department of Anesthesiology and Intensive Care Unit, Medical University of Warsaw, Warsaw, Poland. Electronic address: beata.blaszczyk@gmail.com. 2. I Department of Anesthesiology and Intensive Care Unit, Medical University of Warsaw, Warsaw, Poland. 3. Department of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland.
Abstract
BACKGROUND: Early extubation is a standard procedure after liver transplantation (LT). METHODS: The preoperative and perioperative data of 506 adult patients undergoing LT from July 2000 to March 2015 were analyzed. The goal of this study was to determine preoperative and perioperative independent predictors of early tracheal extubation. RESULTS: Of the 506 study patients, 73.7% were extubated early after LT. Patients in this group exhibited better preoperative and perioperative outcomes. However, according to multivariate logistic regression analysis, only 3 parameters were independent predictors of early extubation: initial hemoglobin concentration (odds ratio [OR], 1.187 [95% confidence interval (CI), 1.033-1.364]), application of epidural anesthesia (OR, 2.762 [95% CI, 1.025-7.445), and units of perioperative packed red blood cells and fresh frozen plasma transfused (OR, 0.919 [95% CI, 0.888-0.952]). CONCLUSIONS: Early extubation of patients undergoing LT is a safe and widely used procedure. However, the decision regarding this procedure should be made after thorough analysis of the patient's current status, the course of operation, and the patient's preoperative parameters. Based on our findings, we believe that the decision regarding early extubation can be aided by taking into account the patient's initial hemoglobin concentration, the number of packed red blood cells and fresh frozen plasma transfused during surgery, and pain control by application of a thoracic epidural catheter.
BACKGROUND: Early extubation is a standard procedure after liver transplantation (LT). METHODS: The preoperative and perioperative data of 506 adult patients undergoing LT from July 2000 to March 2015 were analyzed. The goal of this study was to determine preoperative and perioperative independent predictors of early tracheal extubation. RESULTS: Of the 506 study patients, 73.7% were extubated early after LT. Patients in this group exhibited better preoperative and perioperative outcomes. However, according to multivariate logistic regression analysis, only 3 parameters were independent predictors of early extubation: initial hemoglobin concentration (odds ratio [OR], 1.187 [95% confidence interval (CI), 1.033-1.364]), application of epidural anesthesia (OR, 2.762 [95% CI, 1.025-7.445), and units of perioperative packed red blood cells and fresh frozen plasma transfused (OR, 0.919 [95% CI, 0.888-0.952]). CONCLUSIONS: Early extubation of patients undergoing LT is a safe and widely used procedure. However, the decision regarding this procedure should be made after thorough analysis of the patient's current status, the course of operation, and the patient's preoperative parameters. Based on our findings, we believe that the decision regarding early extubation can be aided by taking into account the patient's initial hemoglobin concentration, the number of packed red blood cells and fresh frozen plasma transfused during surgery, and pain control by application of a thoracic epidural catheter.