Introduction
Liver transplantation (LT) is a well-established curative therapy for irreversible chronic end-stage liver disease or acute liver failure (1-3). Since the introduction of the liver transplant procedure, it has been a standard approach to give postoperative ventilation in children and exact timing of extubation is usually debatable but it has been noted that early or even immediate extubation may be a feasible approach nowadays (4-6). It is important to assess timing of extubation because premature discontinuation can be associated with respiratory complications such as airway obstruction, aspiration of tracheal secretions leading to pneumonia (7) and prolonged ventilation can lead to complications like endobronchial intubation, …show more content…
Delayed extubation was defined as longer than 72 hours.
Anesthesia usage was non-standardized, but most commonly we used Propofol and Etomidate for induction and Isoflurane and Sevoflurane as maintenance agents. Muscle relaxants like Rocuronium, Vecuronium and Cisatracurium were used. Fentanyl and morphine were used as narcotic agents. Intraoperative management was similar for all patients.
Patient’s respiratory rate, blood pressure, ECG, saturation of O2 and CO2 were monitored throughout the procedure. Hemodynamic stability was maintained using packed red cell transfusion or fresh frozen plasma as and when required. Post-operatively extubation was based mainly on preoperative hemoglobin (Hb) and albumin (Alb), previous abdominal surgery, lower intraoperative or postoperative pH, higher estimated blood loss (EBL) and higher volume of the intraoperatively transfused blood products (>30 …show more content…
Unlike previous studies, the length of stay in ICU or total time of hospital stay related to timing of extubation was not discussed. Also, presence of any different factor affecting extubation in living and deceased donors was not addressed. Further larger sample and multi center studies are required to confirm the variables that can effect time of the extubation.
Finally, this study was conducted using multivariate logistic regression model for various variables and explored that factors like younger age, lower preoperative hemoglobin, lower preoperative weight, volume of transfusion of blood products more than 24.785ml/kg and lower pH after induction were considered as significant predictors of delayed extubation following pediatric liver transplant. When a pediatric patient has any of the elements mentioned above, then the reintubation should be weighed against the early extubation even though previous studies have highlighted early or immediate extubation as a better
Liver transplantation (LT) is a well-established curative therapy for irreversible chronic end-stage liver disease or acute liver failure (1-3). Since the introduction of the liver transplant procedure, it has been a standard approach to give postoperative ventilation in children and exact timing of extubation is usually debatable but it has been noted that early or even immediate extubation may be a feasible approach nowadays (4-6). It is important to assess timing of extubation because premature discontinuation can be associated with respiratory complications such as airway obstruction, aspiration of tracheal secretions leading to pneumonia (7) and prolonged ventilation can lead to complications like endobronchial intubation, …show more content…
Delayed extubation was defined as longer than 72 hours.
Anesthesia usage was non-standardized, but most commonly we used Propofol and Etomidate for induction and Isoflurane and Sevoflurane as maintenance agents. Muscle relaxants like Rocuronium, Vecuronium and Cisatracurium were used. Fentanyl and morphine were used as narcotic agents. Intraoperative management was similar for all patients.
Patient’s respiratory rate, blood pressure, ECG, saturation of O2 and CO2 were monitored throughout the procedure. Hemodynamic stability was maintained using packed red cell transfusion or fresh frozen plasma as and when required. Post-operatively extubation was based mainly on preoperative hemoglobin (Hb) and albumin (Alb), previous abdominal surgery, lower intraoperative or postoperative pH, higher estimated blood loss (EBL) and higher volume of the intraoperatively transfused blood products (>30 …show more content…
Unlike previous studies, the length of stay in ICU or total time of hospital stay related to timing of extubation was not discussed. Also, presence of any different factor affecting extubation in living and deceased donors was not addressed. Further larger sample and multi center studies are required to confirm the variables that can effect time of the extubation.
Finally, this study was conducted using multivariate logistic regression model for various variables and explored that factors like younger age, lower preoperative hemoglobin, lower preoperative weight, volume of transfusion of blood products more than 24.785ml/kg and lower pH after induction were considered as significant predictors of delayed extubation following pediatric liver transplant. When a pediatric patient has any of the elements mentioned above, then the reintubation should be weighed against the early extubation even though previous studies have highlighted early or immediate extubation as a better