Clinical practice of early extubation after liver transplantation

Jian Wu, Vaibhav Rastogi and Shu-Sen Zheng
Hangzhou, China

BACKGROUND: Anesthetic practices such as early tracheal
extubation facilitate postoperative recovery. Early extubation
after liver transplantation has been adopted by some centers in
the recent two decades. No universal clinical guidelines are used
and questions remain. This review aimed to address the current
status of early extubation after liver transplantation.
DATA SOURCES: A literature search of MEDLINE and ISI Web
of Knowledge databases was performed using terms such as liver
transplantation, early extubation, immediate tracheal extubation,
fast tracking or fast track anesthesia and postoperative tracheal
extubation. Additional papers were identified by a manual search
of the references in the key articles.
RESULTS: Review of the available literature provided an
insight into the definition, evolution, advantages and risks
of early extubation, and anesthetic techniques that prompt
early extubation in liver transplant patients. Early extubation
has proved to be feasible and safe in these patients, but the
outcomes are still uncertain.
CONCLUSIONS: Early extubation after liver transplantation
is feasible, safe and cost-effective in the majority of patients and
has been increasingly accepted as an option for conventional
postoperative ventilation. Comprehensive and individualized
evaluation of the patient's condition before extubation by an
experienced anesthesiologist is the cornerstone of success.
Understanding of its effect on the outcome remains incomplete.
In the future, additional trials are required to establish universal
early extubation guidelines and to determine its benefits for
patients and practitioners.
(Hepatobiliary Pancreat Dis Int 2012;11:577-585)