Very early tracheal extubation without predetermined criteria in a liver transplant recipient population

This study of all patients undergoing orthotopic liver transplantation (OLT ) at our center between January 1997 and December 1999 evaluated the feasib ility and safety of very early tracheal extubation without previous selecti on. Anesthetic management was the same in all cases, and tracheal extubatio n was performed on the basis of standardized criteria routinely adopted in operating rooms throughout the world, i.e., no residual curarization or ane sthetic action, ability to swallow efficiently, and stable hemodynamics. On e hundred sixty-nine patients underwent 181 OLTs during the study period. T racheal extubation was performed within 3 hours of surgery in 115 cases, 8 hours in 19 cases, and 8 to 24 hours in 10 cases. In 36 cases, artificial v entilation was required for more than 24 hours or weaning was not possible. One patient died of primary graft nonfunction within 24 hours and was excl uded from the analysis. The feasibility of early extubation was influenced by the amount of intraoperative transfused blood; efficacy of kidney, cardi ac, and pulmonary function; and presence of encephalopathy (P < .001). No c orrelation was found with age or pre-OLT severity of hepatic disease, and t he postoperative period was not compromised by early weaning. Very early ex tubation was feasible and safe in a large number of unselected transplant r ecipients, thus suggesting that the definition of early tracheal extubation should be changed from 8 to 3 hours after surgery.