Fast track anesthesia for liver transplantation reduces postoperative ventilation time but not intensive care unit stay.

Fast tracking is an approach to health care delivery that emphasizes the efficient use of resources. This investigation was designed to determine whether shorter-acting drugs and different drug administration practices reduce the length of time for which patients require mechanical ventilation and intensive care after liver transplantation. After obtaining Institutional Review Board approval and informed consent, we randomized 80 consecutive patients (>17 years) undergoing liver transplantation to receive either our traditional anesthetic (thiopental, pancuronium, 50 microg/kg fentanyl), or fast track anesthetic (propofol, cisatracurium, 20 microg/kg fentanyl). The patients were weaned to extubation in the intensive care unit after an established clinical protocol. Measured data included the occurrence of intraoperative hypotension, intraoperative hypertension, intraoperative tachycardia, the length of postoperative mechanical ventilation, length of intensive care unit stay, and episodes of reintubation. Seventy-eight patients remained in the study through the investigation (two died intraoperatively). Operating time; amount of intraoperative red blood cells transfused; lowest body temperature achieved; and minutes of intraoperative hypotension, hypertension, and tachycardia were not different between the traditional and fast track patient groups. Postoperative ventilation time was greater in the patients who received the traditional anesthetic; mean. 1,081 minutes (median, 855) versus mean, 553.5 minutes (median, 390) (P <.001). However, there was no difference in length of intensive care unit stay. Five patients required reintubation (two patients given the traditional anesthetic, three given the fast track anesthetic). We conclude that a fast track approach to anesthetic care reduces the requirement for postoperative mechanical ventilation, but does not reduce intensive care unit stay after liver transplantation.

Chiari I malformation in parturients.

STUDY OBJECTIVE: To assess complications of regional as well as general anesthesia in parturients with Chiari I malformation. DESIGN: Retrospective chart review. SETTING: Academic medical center. PATIENTS: All parturients in our institution who had the diagnosis of Chiari I malformation and delivered in our hospitals over a 50-year period. MAIN RESULTS: 12 parturients delivered 30 babies. Three deliveries were facilitated with general anesthesia. Nine deliveries were facilitated with central axis anesthesia, six with epidural anesthesia, two with a single injection of a spinal anesthetic, and one with a continuous spinal catheter. The patient who received a continuous spinal catheter developed a postdural puncture headache that resolved with an epidural blood patch. None of the patients who received general, spinal, or epidural anesthesia for their deliveries developed symptoms or had exacerbation of preexisting symptoms of Chiari I malformation. CONCLUSIONS: General anesthesia, as well as spinal and epidural anesthesia, appeared to be safe and effective in our series of vaginal or cesarean delivery patients. The small number of patients in our series does not negate the cautious recommendations of others, but suggests that general anesthesia, as well as spinal or epidural anesthesia, can be used safely and effectively in these patients.