Edorium Journal of

Anesthesia

 
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Review Article
 
Factors that may affect early extubation after liver transplantation
Shaima Elnour1, Zoka Milan2
1Consultant Anaesthetist, Anaesthetic Department, King's College Hospital, London, UK.
2Consultant Anaesthetist and Intensivist, Honorary Senior Lecturer, Visiting Professor, Anaesthetic Department, King's College Hospital, London, UK.

Article ID: 100003A05SE2015
doi:10.5348/A05-2015-3-RA-3

Address correspondence to:
Zoka Milan
Anaesthetic Department, King's College Hospital
Denmark Hill, London SE5 9RS
UK
Phone: + 44 203 299 9000
Fax: + 44 203 299 3445

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How to cite this article
Elnour S, Milan Z. Factors that may affect early extubation after liver transplantation. Edorium J Anesth 2015;1:10–15.


Abstract
It has been suggested that early extubation following liver transplantation (LT) contributes to increased patient and graft survival, shortened hospital stay, and reduced treatment costs. However, few studies have been performed on the clinical criteria for early extubation. Although early extubation criteria are the same as those for any other surgical patient, it is a complex decision for patients who have undergone LT, and there is a learning curve, as it can take some time to increase the early extubation success rate. We summarized and discussed all of the factors reported in the literature that could influence the decision to fast-track patients scheduled for LT. We suggest that the planning process should start earlier, and that potential candidates for early extubation be determined during a pre-assessment session. We divided clinical factors into pre-operative, intra-operative, and post-operative. Intra-operative factors were further divided into factors related to the patient, anesthesia, and graft or surgery quality. We suggest an early extubation strategy following LT that supports the decision-making process and helps accelerate the learning curve for early extubation. Our results may help clinicians with decision-making and can be a platform for additional large, retrospective studies or randomized controlled trials.

Keywords: Liver transplant, Pre-assessment, Fast track

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Author Contributions
Shaima Elnour – Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Zoka Milan – Substantial contributions to conception and design, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Shaima Elnour et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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