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Rodríguez-Laiz GP, Melgar P, Alcázar-López C, Franco-Campello M, Martínez-Adsuar F, Navarro-Martínez J, Gómez-Salinas L, Pascual S, Bellot P, Carnicer F, Rodríguez-Soler M, Palazón JM, Mas-Serrano P, Almanza-López S, Jaime-Sánchez F, Perdiguero M, de Santiago C, Lozano T, Irurzun J, Pérez E, Merino E, Zapater P, Lluís F. Enhanced recovery after low- and medium-risk liver transplantation. A single-center prospective observational cohort study. Int J Surg 2020; 85:46-54. [PMID: 33338651 DOI: 10.1016/j.ijsu.2020.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/26/2020] [Accepted: 12/11/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND & AIMS Few studies have fully applied an enhanced recovery after surgery (ERAS) protocol to liver transplantation (LT). Our aim was to assess the effects of a comprehensive ERAS protocol in our cohort of low- and medium-risk LT patients. METHODS The ERAS protocol included pre-, intra-, and post-operative steps. During the five-year study period, 181 LT were performed in our institution. Two cohorts were identified: low risk patients (n = 101) had a laboratory model for end-stage liver disease (MELD) score of 20 points or less at the time of LT, received a liver from a donor after brain death, and had a balance of risk score of 9 points or less; medium-risk patients (n = 15) had identical characteristics except for a higher MELD score (21-30 points). In addition, we analyzed the remaining patients (n = 65) who were transplanted over the same study period separately using the ERAS protocol. RESULTS The low-risk cohort showed a low need for packed red blood cells transfusion (median: 0 units) and renal replacement therapy (1%), as well as a short length of stay both in the intensive care unit (13 h) and in the hospital (4 days); morbidity during one-year follow-up, and probability of surviving to one year (89.30%) and five years (76.99%) were in line with well-established reference data. Similar findings were observed in the medium-risk cohort. CONCLUSIONS This single-center prospective observational cohort study provides evidence that ERAS is feasible and safe for low- and medium-risk LT.
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Affiliation(s)
- Gonzalo P Rodríguez-Laiz
- Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Paola Melgar
- Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain.
| | - Cándido Alcázar-López
- Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Mariano Franco-Campello
- Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Francisco Martínez-Adsuar
- Anesthesiology and Surgical Critical Care, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - José Navarro-Martínez
- Anesthesiology and Surgical Critical Care, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Luís Gómez-Salinas
- Anesthesiology and Surgical Critical Care, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Sonia Pascual
- Gastroenterology and Hepatology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Pau Bellot
- Gastroenterology and Hepatology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Fernando Carnicer
- Gastroenterology and Hepatology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - María Rodríguez-Soler
- Gastroenterology and Hepatology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - José M Palazón
- Gastroenterology and Hepatology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Patricio Mas-Serrano
- Pharmacy and Pharmacokinetics, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Susana Almanza-López
- Critical Care Medicine, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Francisco Jaime-Sánchez
- Critical Care Medicine, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Miguel Perdiguero
- Nephrology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Carlos de Santiago
- Transplant Coordination, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Teresa Lozano
- Cardiology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Javier Irurzun
- Radiology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Enrique Pérez
- Psychiatry, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Esperanza Merino
- Infectious Diseases, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Pedro Zapater
- Clinical Pharmacology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Félix Lluís
- Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Alonso-García FJ, Navarro-Martínez J, Gálvez C, Rivera-Cogollos MJ, Sgattoni C, Tarí-Bas IM. [Single-port video-assisted thoracic surgery in an awake patient]. Rev Esp Anestesiol Reanim 2016; 63:177-180. [PMID: 26298720 DOI: 10.1016/j.redar.2015.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 06/04/2023]
Abstract
Video-assisted thoracic surgery is traditionally carried out with general anaesthesia and endotracheal intubation with double lumen tube. However, in the last few years procedures, such as lobectomies, are being performed with loco-regional anaesthesia, with and without sedation, maintaining the patient awake and with spontaneous breathing, in order to avoid the inherent risks of general anaesthesia, double lumen tube intubation and mechanical ventilation. This surgical approach has also shown to be effective in that it allows a good level of analgesia, maintaining a correct oxygenation and providing a better post-operative recovery. Two case reports are presented in which video-assisted thoracic surgery was used, a lung biopsy and a lung resection, both with epidural anaesthesia and maintaining the patient awake and with spontaneous ventilation, as part of a preliminary evaluation of the anaesthetic technique in this type of surgery.
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Affiliation(s)
- F J Alonso-García
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General de Alicante, Alicante, España.
| | - J Navarro-Martínez
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General de Alicante, Alicante, España
| | - C Gálvez
- Servicio de Cirugía torácica, Hospital General de Alicante, Alicante, España
| | - M J Rivera-Cogollos
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General de Alicante, Alicante, España
| | - C Sgattoni
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General de Alicante, Alicante, España
| | - I M Tarí-Bas
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General de Alicante, Alicante, España
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Navarro-Martínez J, Barrera E, Trillo L, Martí J, Delclós J, Escolano F. [Failure in the functioning of an implanted automatic defibrillator due to pneumothorax occurring during its implantation ]. Rev Esp Anestesiol Reanim 2002; 49:268-71. [PMID: 12216510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
A 67-year-old man with chronic bronchitis and coronary artery disease was scheduled to receive an implantable cardioverter defibrillator (ICD) after an episode of sustained monomorphic ventricular tachycardia. During implantation through the left subclavian vein, oxygen saturation decreased to slightly below baseline. Nevertheless, the procedure continued, given that the patient experienced neither breathing difficulties nor pain. When the ICD failed to reverse ventricular fibrillation induced to test the device, an external defibrillator was used. At that point, left-sided pneumothorax was observed by x-ray. Air in the pleural cavity caused an increase in the defibrillation threshold. After insertion of a thoracic drain, the ICD implantation procedure was completed successfully.
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Affiliation(s)
- J Navarro-Martínez
- Servicio de Anestesiología y Reanimación, Hospital Universitario del Mar-Esperanza (IMAS), Passeig Maritim 25-29 08003, Barcelona.
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