Study objective: To evaluate whether our criteria for immediate postoperative extubation predicts successful extubation in living-related liver transplantation of the right lobe, and to test the effects of our standardized anesthetic technique on the success of immediate postoperative extubation.
Design: Open-label, descriptive study.
Setting: University hospital.
Patients: 6 ASA physical status III and IV patients with end-stage liver disease undergoing living-related liver transplantation of the right lobe.
Interventions: Patients received a standardized anesthetic technique with propofol, remifentanil, and cisatracurium. They were extubated when they met our criteria for immediate postoperative extubation: good donor liver function, <10 U packed red blood cells administered, hemodynamic stability, and alveolar-arterial oxygen gradient <200 mmHg.
Measurements and main results: At the end of surgery, four of the six patients fulfilled our criteria for immediate postoperative extubation. They were uneventfully extubated rapidly after surgery and soon arrived in the intensive care unit. Their postoperative stay in the operating room was only 36 minutes (range: 30 to 42 min). No patient required reintubation in the operating room or the intensive care unit. They had no recorded hemodynamic or respiratory problems postoperatively.
Conclusions: Immediate extubation of selected living-related liver transplant recipients can be a safe procedure. Anesthetic management to immediate extubation seems appropriate and the derived guidelines appear acceptable.