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Immediate Extubation in the Operating Room Following Pediatric Liver Transplantation: A Retrospective Cohort Study
Taylan Sahin1, Ayhan Yaman2, Ali Sait Kavakli1
1Department of Anaesthesiology and Reanimation, Istinye University, Faculty of Medicine, Istanbul, Turkey.
Insights
Immediate extubation in the operating room after pediatric liver transplantation is safe and efficient. Factors like anesthesia duration and blood product use can guide decisions for immediate extubation (IE) versus delayed extubation (DE).
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Transplantation Medicine
Background:
- Immediate extubation in the operating room (OR) after pediatric liver transplantation is underutilized despite potential benefits.
- Surgeons and anesthesiologists often exhibit caution regarding OR extubation in this patient population.
Purpose of the Study:
- To evaluate the safety and efficiency of immediate extubation in the OR following pediatric liver transplantation.
- To compare outcomes between immediate extubation (IE) and delayed extubation (DE) groups.
Main Methods:
- Retrospective study of 64 pediatric liver transplant recipients.
- Patients categorized into IE (extubated in OR) and DE (extubated in ICU) groups.
- Analysis of preoperative, intraoperative, and postoperative variables.
Main Results:
- 70.3% of patients underwent IE, while 29.7% had DE.
- DE group showed higher fresh frozen plasma and platelet use (P=.017, P=.002).
- DE group had longer anesthesia duration (P=.020), ICU stay (P=.0001), and hospital stay (P=.012).
- Reintubation rates were 4.4% for IE and 15.8% for DE.
Conclusions:
- Immediate extubation in the OR is a safe strategy for pediatric liver transplant recipients.
- Anesthesia duration and intraoperative blood product requirements (platelets, FFP) are key indicators for successful IE.
Background:
Although immediate extubation in the operating room following pediatric liver transplantation can be safe and beneficial for select patients, many surgeons and anesthesiologists are still cautious. The study aimed to evaluate the safety and efficiency of immediate extubation in the operating room following pediatric liver transplantation.
Methods:
Sixty-four pediatric liver transplant recipients were included in this retrospective study. Patients were divided into 2 groups: immediate extubation (IE) (those who were extubated in the operating room) and delayed extubation (DE) (those who were extubated in the intensive care unit). Preoperative, intraoperative, and postoperative variables were recorded.
Results:
Although a total of 19 (29.7%) patients were extubated in the pediatric intensive care unit (group DE), 45 (70.3%) were extubated in the operating room at the end of surgery (group IE). The use of fresh frozen plasma and platelets was statistically higher in group DE (P = .017 and P = .002, respectively). Duration of anesthesia and length of stay in the pediatric intensive care unit was statistically longer in group DE (P = .020 and P = .0001, respectively). Three (15.8%) patients required reintubation in group DE and 2 (4.4%) in group IE. Hospital stay was statistically longer in group DE (P = .012).
Conclusions:
The current study demonstrated that immediate extubation in the operating room after surgery for pediatric patients who have undergone liver transplantation was safe. The duration of anesthesia and the intraoperative use of blood products such as platelet and fresh frozen plasma can effectively decide immediate extubation.
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