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1.
Transplantation ; 105(9): 2018-2028, 2021 09 01.
Article in English | MEDLINE | ID: mdl-32890127

ABSTRACT

BACKGROUND: Fast-track anesthesia in liver transplantation (LT) has been discussed over the past few decades; however, factors associated with immediate extubation after LT surgery are not well defined. This study aimed to identify predictive factors and examine impacts of immediate extubation on post-LT outcomes. METHODS: A total of 279 LT patients between January 2014 and May 2017 were included. Primary outcome was immediate extubation after LT. Other postoperative outcomes included reintubation, intensive care unit stay and cost, pulmonary complications within 90 days, and 90-day graft survival. Logistic regression was performed to identify factors that were predictive for immediate extubation. A matched control was used to study immediate extubation effect on the other postoperative outcomes. RESULTS: Of these 279 patients, 80 (28.7%) underwent immediate extubation. Patients with anhepatic time >75 minutes and with total intraoperative blood transfusion ≥12 units were less likely to be immediately extubated (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.26-0.89; P = 0.02; OR, 0.11; 95% CI, 0.05-0.21; P < 0.001). The multivariable analysis showed immediate extubation significantly decreased the risk of pulmonary complications (OR, 0.34; 95% CI, 0.15-0.77; P = 0.01). According to a matched case-control model (immediate group [n = 72], delayed group [n = 72]), the immediate group had a significantly lower rate of pulmonary complications (11.1% versus 27.8%; P = 0.012). Intensive care unit stay and cost were relatively lower in the immediate group (2 versus 3 d; P = 0.082; $5700 versus $7710; P = 0.11). Reintubation rates (2.8% versus 2.8%; P > 0.9) and 90-day graft survival rates (95.8% versus 98.6%; P = 0.31) were similar. CONCLUSIONS: Immediate extubation post-LT in appropriate patients is safe and may improve patient outcomes and resource allocation.


Subject(s)
Airway Extubation , Liver Transplantation , Lung Diseases/prevention & control , Time-to-Treatment , Airway Extubation/adverse effects , Airway Extubation/economics , Cost Savings , Cost-Benefit Analysis , Female , Graft Survival , Health Care Costs , Health Care Rationing , Humans , Length of Stay , Liver Transplantation/adverse effects , Liver Transplantation/economics , Lung Diseases/diagnosis , Lung Diseases/economics , Lung Diseases/etiology , Male , Middle Aged , Protective Factors , Retreatment , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
2.
Anesthesiol Clin ; 38(1): 51-66, 2020 Mar.
Article in English | MEDLINE | ID: mdl-32008657

ABSTRACT

The number of patients presenting for surgery with renal dysfunction requiring renal replacement therapy (RRT) is expected to increase as the population ages and improvements in therapy continue to be made. Every aspect of the perioperative period is affected by renal dysfunction, its associated comorbidities, and altered physiology secondary to RRT. Most alarming is the increased risk for perioperative cardiac morbidity and mortality seen in this population. Perioperative optimization and management aims to minimize these risks; however, few definite guidelines on how to do so exist.


Subject(s)
Anesthesia/methods , Renal Replacement Therapy , Fluid Therapy , Humans , Kidney Failure, Chronic/therapy , Preoperative Care , Vascular Access Devices , Water-Electrolyte Imbalance/complications
3.
J Cardiothorac Vasc Anesth ; 33(12): 3303-3308, 2019 Dec.
Article in English | MEDLINE | ID: mdl-30850225

ABSTRACT

OBJECTIVE: To compare outcomes among patients with and without preprocedural radial arterial catheters who underwent transfemoral transcatheter aortic valve replacement (TF-TAVR) under deep intravenous (IV) sedation and to assess predictive variables for preprocedural placement. DESIGN: Single-center, retrospective, cohort analysis. SETTING: Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, which is a tertiary care, university-affiliated hospital. PARTICIPANTS: The study comprised 157 patients. The primary focus was the 106 patients who underwent TF-TAVR when routine placement of preprocedure radial arterial catheters was abandoned. They were analyzed for hospital length of stay, 30-day mortality, and predictive factors of preprocedure placement. The remaining patients served as historical controls when routine radial artery catheter placement was practiced. INTERVENTIONS: Patient, procedure, and provider factors were analyzed. The transitional period consisted of 169 consecutive days from April 13 to September 28, 2017. A reference group of historical patients served as a control. MEASUREMENTS AND MAIN RESULTS: Seventy-five of 106 patients did not have a preprocedural radial arterial catheter. The primary outcome measures of length of stay and 30-day mortality within the transitional group were not different. Secondary outcome measures included identification of predictive variables for preprocedure placement and outcome comparisons between the transitional and historical groups. Anesthesia provider (p = 0.015) and ejection fraction (p = 0.039) were significant factors. There were no differences in outcome measures. CONCLUSION: There was no difference in primary outcomes in patients with or without radial arterial catheters for TF-TAVR. The findings of this study suggest anesthesia provider and ejection fraction were significant factors for preprocedural placement.


Subject(s)
Aortic Valve Stenosis/surgery , Blood Pressure/physiology , Catheterization, Peripheral/methods , Conscious Sedation/methods , Monitoring, Physiologic/methods , Transcatheter Aortic Valve Replacement/methods , Aged , Aortic Valve/surgery , Aortic Valve Stenosis/diagnosis , Echocardiography, Transesophageal , Female , Femoral Artery , Follow-Up Studies , Humans , Length of Stay/trends , Male , Radial Artery , Retrospective Studies , Risk Factors , Time Factors
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