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World J Hepatol. Sep 18, 2015; 7(20): 2303-2308
Published online Sep 18, 2015. doi: 10.4254/wjh.v7.i20.2303
Fast track anesthesia for liver transplantation: Review of the current practice
Stephen Aniskevich, Sher-Lu Pai
Stephen Aniskevich, Sher-Lu Pai, Department of Anesthesiology, Division of Hepatobiliary and Abdominal Organ Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, United States
Author contributions: Aniskevich S and Pai SL contributed to the writing and editing of this manuscript.
Conflict-of-interest statement: The authors have no relevant conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Stephen Aniskevich, MD, Department of Anesthesiology, Division of Hepatobiliary and Abdominal Organ Transplant, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224, United States. stephen2@mayo.edu
Telephone: +1-904-9533328 Fax: +1-904-9563332
Received: February 12, 2015
Peer-review started: February 12, 2015
First decision: June 2, 2015
Revised: June 26, 2015
Accepted: August 28, 2015
Article in press: September 7, 2015
Published online: September 18, 2015
Processing time: 215 Days and 16.2 Hours
Abstract

Historically, patients undergoing liver transplantation were left intubated and extubated in the intensive care unit (ICU) after a period of recovery. Proponents of this practice argued that these patients were critically ill and need time to be properly optimized from a physiological and pain standpoint prior to extubation. Recently, there has been a growing movement toward early extubation in transplant centers worldwide. Initially fueled by research into early extubation following cardiac surgery, extubation in the operating room or soon after arrival to the ICU, has been shown to be safe with proper patient selection. Additionally, as experience at determining appropriate candidates has improved, some institutions have developed systems to allow select patients to bypass the ICU entirely and be admitted to the surgical ward after transplant. We discuss the history of early extubation and the arguments in favor and against fast track anesthesia. We also described our practice of fast track anesthesia at Mayo Clinic Florida, in which, we extubate approximately 60% of our patients in the operating room and send them to the surgical ward after a period of time in the post anesthesia recovery unit.

Keywords: Liver transplant; Fast track anesthesia; Early extubation; Intensive care; Liver failure

Core tip: With proper patient selection, early extubation and bypassing of the intensive care unit is possible for patients undergoing liver transplantation. This needs a multidisciplinary approach and institutional support to be effective and can improve patient outcomes, as well as, improving resource utilization.