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BackgroundIn the era of enhanced recovery after surgery, there is significant discussion regarding the impact of intraoperative anesthetic management on short-term outcomes following liver transplantation (LT), with no clear consensus in the literature.ObjectivesTo identify whether or not intraoperative anesthetic management affects short-term outcomes after liver transplantation.Data sourcesOvid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.MethodsA systematic review following PRISMA guidelines was undertaken. The systematic review was registered on PROSPERO (CRD42021239758). An international expert panel made recommendations for clinical practice using the GRADE approach.ResultsAfter screening, 14 studies were eligible for inclusion in this systematic review. Six were prospective randomized clinical trials, three were prospective nonrandomized clinical trials, and five were retrospective studies. These manuscripts were reviewed to look at five questions regarding anesthetic care and its impact on short term outcomes following liver transplant. After review of the literature, the quality of evidence according to the following outcomes was as follows: intraoperative and postoperative morbidity and mortality (low), early allograft dysfunction (low), and hospital and ICU length of stay (moderate).ConclusionsFor optimal short term outcomes after liver transplantation, the panel recommends the use of volatile anesthetics in preference to total intravenous anesthesia (TIVA) (Level of Evidence: Very low; Strength of Recommendation: Weak) and minimum alveolar concentration (MAC) versus bispectral index (BIS) for depth of anesthesia monitoring (Level of Evidence: Very low; Strength of Recommendation: Weak). Regarding ventilation and oxygenation, the panel recommends a restrictive oxygenation strategy targeting a PaO2 of 70-120 mmHg (10-14 kPa), a tidal volume of 6-8 ml/kg ideal body weight (IBW), administration of positive end expiratory pressure (PEEP) tailored to patient intraoperative physiology, and recruitment maneuvers. (Level of evidence: Very low; Strength of Recommendation: Strong). Finally, the panel recommends the routine use of antiemetic prophylaxis. (Level of evidence: low; Strength of Recommendation: Strong).

Thirst discomfort is common because patients are required to undergo long periods of fasting before medical and surgical procedures. The aim of this study was to examine the validity and reliability of the peri-operative thirst discomfort scale (PTDS) for measuring thirst discomfort before procedures. Fasting patients who were scheduled for an elective cardiac or interventional radiology procedure were included in a prospective observational study. Mokken scaling analysis was used to investigate the dimensionality and hierarchical nature of the PTDS. PTDS scores were compared with fasting duration to evaluate construct validity. Convergent validity was evaluated by comparing the PTDS with global thirst discomfort and thirst intensity ratings. Five items from the peri-operative thirst discomfort scale (PTDS-5) formed a Mokken scale with evidence of invariant item ordering. Participants most easily endorsed the item related to the desire to drink water through to first endorsing symptoms related to dryness of the mouth and lips before those related to the abnormal sensations of "thick" saliva and "thick" tongue. Scale reliability was adequate (rho = 0.84). There was a positive correlation between PTDS-5 scores and the global thirst discomfort rating (tau = 0.54; 95% CI = 0.43 to 0.63), as well as thirst intensity (tau = 0.49; 95% CI = 0.38 to 0.59). Duration of fasting was not associated with PTDS-5 scores. The items in the PTDS-5 form a strong Mokken scale, meaning it is a reliable and precise way to order patients according to their thirst discomfort. • The items in the 5-item peri-operative thirst discomfort scale may provide a reliable and precise way to order patients according to their thirst discomfort before procedures in interventional radiology or cardiac cath lab settings. • The hierarchical pattern of responses to items in the 5-item peri-operative thirst discomfort scale is interpretable in terms of respondents more easily endorsing items related to a general desire to drink water through to first endorsing more specific symptoms related to dryness of the mouth and lips prior to endorsing discomfort associated with the sensations of "thick" saliva and "thick" tongue. • In more practical terms, a patient who reports feeling bothered by a sensation of thick saliva could be interpreted as experiencing worse thirst discomfort than a patient who did not endorse any of the items lower down on the item difficulty hierarchy (i.e., "my lips are dry" and "my mouth is dry"). [ABSTRACT FROM AUTHOR]