Fast track anesthesia for liver transplantation: Review of the current practice
Historically,patients undergoing liver transplantation were left intubated and extubated in the intensive care unit(ICU)after a period of recovery.Proponents of this practice argued that these patients were critically ill andneed time to be properly optimized from a physiological and pain standpoint...
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| Published in: | World journal of hepatology Vol. 7; no. 20; pp. 2303 - 2308 |
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| Main Authors: | , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
Baishideng Publishing Group Inc
18-09-2015
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Historically,patients undergoing liver transplantation were left intubated and extubated in the intensive care unit(ICU)after a period of recovery.Proponents of this practice argued that these patients were critically ill andneed time to be properly optimized from a physiological and pain standpoint prior to extubation.Recently,there has been a growing movement toward early extubation in transplant centers worldwide.Initially fueled by research into early extubation following cardiac surgery,extubation in the operating room or soon after arrival to the ICU,has been shown to be safe with proper patient selection.Additionally,as experience at determining appropriate candidates has improved,some institutions have developed systems to allow select patients to bypass the ICU entirely and be admitted to the surgical ward after transplant.We discuss the history of early extubation and the arguments in favor and against fast track anesthesia.We also described our practice of fast track anesthesia at Mayo Clinic Florida,in which,we extubate approximately 60%of our patients in the operating room and send them to the surgical ward after a period of time in the post anesthesia recovery unit. |
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| Bibliography: | Historically,patients undergoing liver transplantation were left intubated and extubated in the intensive care unit(ICU)after a period of recovery.Proponents of this practice argued that these patients were critically ill andneed time to be properly optimized from a physiological and pain standpoint prior to extubation.Recently,there has been a growing movement toward early extubation in transplant centers worldwide.Initially fueled by research into early extubation following cardiac surgery,extubation in the operating room or soon after arrival to the ICU,has been shown to be safe with proper patient selection.Additionally,as experience at determining appropriate candidates has improved,some institutions have developed systems to allow select patients to bypass the ICU entirely and be admitted to the surgical ward after transplant.We discuss the history of early extubation and the arguments in favor and against fast track anesthesia.We also described our practice of fast track anesthesia at Mayo Clinic Florida,in which,we extubate approximately 60%of our patients in the operating room and send them to the surgical ward after a period of time in the post anesthesia recovery unit. Stephen Aniskevich;Sher-Lu Pai;Department of Anes- thesiology, Division of Hepatobiliary and Abdominal Organ Transplant, Mayo Clinic Florida Liver transplant;Fast track anesthesia;Early extub ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 Correspondence to: Stephen Aniskevich, MD, Department of Anesthesiology, Division of Hepatobiliary and Abdominal Organ Transplant, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224, United States. stephen2@mayo.edu Telephone: +1-904-9533328 Fax: +1-904-9563332 Author contributions: Aniskevich S and Pai SL contributed to the writing and editing of this manuscript. |
| ISSN: | 1948-5182 1948-5182 |
| DOI: | 10.4254/wjh.v7.i20.2303 |