Early extubation after liver transplantation: Is dexmedetomidine a good option?: A retrospective cohort study

Abstract

Background Dexmedetomidine is a potent and highly selective alpha‐2 adrenoceptor agonist with sympatholytic, sedative, anxiolytic and analgesic properties. The aim of this study is to determine the effect of a dexmedetomidine infusion in liver transplant recipients in the early postoperative period on early and smooth extubation. Methods We performed a retrospective chart review of 21 patients undergoing liver transplantation between December 1, 2018 and February 31, 2020. Patients were divided into the dexmedetomidine and midazolam groups. The primary outcome was the extubation time. Secondary outcomes were mean arterial pressure and heart rate before and after extubation. The collected data included the patients’ age, gender, surgery time, Model for End‐stage Liver Disease score, cold ischemia time, blood transfusion amount and extubation visual analogue scale (VAS) scores. Results Extubation time was significantly shorter in the dexmedetomidine group than in the midazolam group (median [minimum‐maximum], 4 [0‐6], 8 [4‐13] hours, respectively, P = .000). Extubation VAS scores were statistically significantly lower in dexmedetomidine group (P = .000). Mean arterial pressure values before and after extubation were significantly higher in patients' midazolam group than the dexmedetomidine group (P = .003, P = .005, respectively). Conclusions Dexmedetomidine infusions provided early and smooth extubation with stable haemodynamics in our patients.

Trends in sedation‐analgesia practices in pediatric liver transplant patients admitted postoperatively to the pediatric intensive care unit: An analysis of data from the pediatric health information system (PHIS) database

“…Previous studies have shown that delayed extubation of post‐transplant liver patients increases the duration of stay in the PICU. This in part due to the increased use of analgesics and sedatives for tolerance of the MV in these patients 3,4,27,33–35 . The study also found an increased percentage of sedative and analgesic use in those under 1 year of age compared with other age groups.…”

“…This in part due to the increased use of analgesics and sedatives for tolerance of the MV in these patients. 3,4,27,[33][34][35] The study also found an increased percentage of sedative and analgesic use in those under 1 year of age compared with other age groups. This finding of increased medication use in infants even though the half-life of opioids is prolonged in infants due to reduced clearance and the half-life of benzodiazepines may be prolonged due to critical illness, MV, decreased protein binding, and increased volume of distribution.…”

“…Dexmedetomidine is used as an adjunct sedative agent with opioids in intubated patients while on MV; it allows for a reduction in the dosing of opioids 25,26 . The advantages of dexmedetomidine include its minimal effect on respiration (maintains respiratory drive), its predictable hemodynamic effects, allowance for neurological assessment due to easy arousal, as well as the ability to mitigate postoperative agitation and delirium 2,27 . All the above properties of dexmedetomidine make it a useful agent for use in the liver transplant patient in the immediate postoperative period.…”

Effect of dexmedetomidine on liver transplantation: a meta-analysis

“…No new clinical trial was found after searching the clinical trial registration platform ClinicalTrial.gov and WHO ICTRP. Finally, nine studies were included in the meta-analysis, with a total of 648 participants ( Choi et al, 2016 ; Fayed et al, 2016 ; Sayed and Yassen, 2016 ; Xu et al, 2016 ; Lee et al, 2020 ; Lee et al, 2021 ; Ustun et al, 2021 ; Zhang et al, 2021 ; Zhang et al, 2022 ). See Figure 1 for the combined search results.…”