Early extubation after single-lung transplantation: analysis of the first 106 cases

Abstract

Objective: To determine if a modern anesthetic approach permits extubation immediately after surgery for single-lung transplantation.

Design: A retrospective study of all patients undergoing single-lung transplantation from June 1993 to December 1999 in Denmark.

Setting: Rigshospitalet, Copenhagen University hospital.

Participants: One hundred six consecutive patients scheduled for single-lung transplantation.

Interventions: From July 1997, the anesthetic approach was changed to facilitate early extubation. The changes included epidural analgesia and short-acting anesthetic drugs.

Measurements and main results: One hundred six patients were anesthetized for single-lung transplantation. The first 33 patients were moved to the intensive care unit for postoperative mechanical ventilation. After the change of anesthesia technique, 53 of 73 patients were extubated in the operating room. Eleven patients needed reintubation within the first 24 hours because of respiratory insufficiency, pulmonary edema, hemorrhage, or pneumothorax. The need for reintubation increased the length of stay in the intensive care unit by 1 day from 2 to 3 days (NS). The possibility of early extubation or the need for reintubation was not related to age, weight, sex, preoperative condition, mode of transport of the graft, duration of graft ischemia, or side of transplantation.

Conclusion: This study has shown that it is possible to extubate patients in the operating room immediately after single-lung transplantation in the majority of cases.