Clinical application of fast-track anesthesia with early tracheal extubation after liver transplantation

doi:10.3877/cma.j.issn.2095-3232.2026.03.015

Abstract

Abstract:

Objective

To evaluate the feasibility of fast-track anesthesia with early tracheal extubation in orthotopic liver transplantation.

Methods

Clinical data of 8 patients who underwent liver transplantation in the First Affiliated Hospital of Guangzhou Medical University from January 2024 to January 2025 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 7 patients were male and 1 female, aged from 34 to 62 years, with a median age of 48 years. Intraoperative and postoperative conditions were observed. The length of ICU and postoperative hospital stay were recorded.

Results

All 8 patients successfully completed the surgery. Early tracheal extubation was performed. The operation time was 347 (255-510) min, the anhepatic phase was 50 (38-79) min, intraoperative blood loss was 400 (50-800) ml, and the time of tracheal extubation was 45 (20-70) min after surgery. No second intubation in ICU stay, postoperative pulmonary infection or perioperative death occurred. ALT and TB levels tended to decline within postoperative 1 week. Blood gas and pH were basically maintained within the normal range within postoperative 3 d. No serious acid-base balance disorder occurred. The length of ICU stay was 2 (0-5) d. The length of postoperative hospital stay was 21 (12-41) d.

Conclusions

For eligible cases, it is safe and feasible to perform early tracheal extubation after liver transplantation. Fast-track anesthesia exerts a positive effect on rehabilitation after liver transplantation.

Key words: Early tracheal extubation, Enhanced recovery after surgery(ERAS), Fast-track anesthesia, Liver transplantation

Jianliang Yang, Ailing Zhang, Xiaoming Wang, Tianxing Dai, Feng Yuan, Canhua Zhu, Lan Lan, Hanyu Yang, Guoying Wang. Clinical application of fast-track anesthesia with early tracheal extubation after liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(03): 398-404.

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References 29

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例序	性别	年龄	诊断	合并症	Child-Pugh评分	MELD评分	ECOG-PS评分
1	男	43	肝恶性肿瘤(肝癌综合治疗后)	2型糖尿病	5	2	0
2	男	39	肝恶性肿瘤(肝癌综合治疗后)	无	5	6	0
3	男	34	肝恶性肿瘤(肝癌综合治疗后)	无	9	11	0
4	男	62	肝恶性肿瘤(肝癌综合治疗后)	2型糖尿病	6	3	1
5	男	52	肝硬化脾切除术后+门静脉血栓	无	7	5	1
6	男	46	肝恶性肿瘤(肝癌综合治疗后)	无	6	5	0
7	男	51	肝恶性肿瘤(左肝癌切除术后)	2型糖尿病	5	7	0
8	女	50	肝恶性肿瘤(肝癌综合治疗后)	无	7	5	1

例序	性别	年龄	诊断	合并症	Child-Pugh评分	MELD评分	ECOG-PS评分
1	男	43	肝恶性肿瘤(肝癌综合治疗后)	2型糖尿病	5	2	0
2	男	39	肝恶性肿瘤(肝癌综合治疗后)	无	5	6	0
3	男	34	肝恶性肿瘤(肝癌综合治疗后)	无	9	11	0
4	男	62	肝恶性肿瘤(肝癌综合治疗后)	2型糖尿病	6	3	1
5	男	52	肝硬化脾切除术后+门静脉血栓	无	7	5	1
6	男	46	肝恶性肿瘤(肝癌综合治疗后)	无	6	5	0
7	男	51	肝恶性肿瘤(左肝癌切除术后)	2型糖尿病	5	7	0
8	女	50	肝恶性肿瘤(肝癌综合治疗后)	无	7	5	1

例序	手术时间(min)	无肝期（min)	术中出血量(ml)	术中输血量	ICU住院时间(d)	术后住院时间(d)	出院后30 d再入院
1	298	38	200	血浆400 ml	2	14	无
2	255	42	50	血浆400 ml	1	12	无
3	380	65	600	红细胞6 U, 血浆600 ml	0	24	无
4	315	39	600	红细胞6 U, 血浆550 ml	1	17	无
5	270	38	200	血浆1 100 ml	1	15	无
6	415	58	500	红细胞4 U, 血浆900 ml	5	20	无
7	510	79	800	红细胞13 U, 血浆400 ml	2	41	有
8	340	45	500	红细胞6.5 U, 血浆400 ml	3	29	无

例序	手术时间(min)	无肝期（min)	术中出血量(ml)	术中输血量	ICU住院时间(d)	术后住院时间(d)	出院后30 d再入院
1	298	38	200	血浆400 ml	2	14	无
2	255	42	50	血浆400 ml	1	12	无
3	380	65	600	红细胞6 U, 血浆600 ml	0	24	无
4	315	39	600	红细胞6 U, 血浆550 ml	1	17	无
5	270	38	200	血浆1 100 ml	1	15	无
6	415	58	500	红细胞4 U, 血浆900 ml	5	20	无
7	510	79	800	红细胞13 U, 血浆400 ml	2	41	有
8	340	45	500	红细胞6.5 U, 血浆400 ml	3	29	无

例序	ALT(U/L)			TB(μmol/L)			血气pH
例序	1 d	3 d	7 d	1 d	3 d	7 d	1 d	3 d	7 d
1	167	147	62	24.5	23.1	20.5	7.24	7.35	7.38
2	324	280	120	44.8	37.1	21	7.35	7.39	7.34
3	601	539	47	131.9	112.4	36.3	7.34	7.44	7.41
4	130	73	21	15.2	11.8	9.7	7.41	7.44	7.46
5	438	234	162	51.9	42.2	39.7	7.39	7.38	7.46
6	187	180	93	33	33.1	26	7.29	7.37	7.4
7	597	416	137	98.5	59.4	44.3	7.36	7.36	7.41
8	1 376	679	278	110.6	41.4	26.5	7.41	7.41	7.43

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