Journal List > J Korean Soc Transplant > v.32(3) > 1101779

Kim and Koo: Anesthetic Management in Pediatric Liver Transplantation

Abstract

An increasing number of pediatric patients undergo liver transplantation, and it has become an effective and definitive treatment of choice for pediatric end-stage liver disease patients. However, liver transplantation in pediatric patients differs greatly from that in older individuals with respect to not only surgical techniques, immunosuppression, and postoperative managements, but also to intraoperative anesthetic management. The present review provides an overview of the current development and clinical practices in anesthetic management of pediatric liver transplantation.

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Fig. 1.
Patient warming devices. Bair hugger warming unit (A), Bair hugger warming blanket (B), Hotline fluid warming devices for IV fluid and blood (C).
jkstn-32-31f1.tif
Table 1.
Surgical stages and related anesthetic concerns
Surgical stage Anesthetic concerns
Preanhepatic (dissection)
  Dissection of diseased liver Large blood loss
Fluid and blood products resuscitation
Anhepatic
  IVC clamped Fluid management
Correction of metabolic abnormalities; hyperkalemia, hypocalcemia, acidosis
  Removal of diseased liver Prepare for reperfusion with adequate volume resuscitation and titration
Reperfusion Correction of metabolic abnormalities; hyperkalemia, hypocalcemia, acidosis
Air embolism
Neohepatic
  Hepatic artery anastomosis Hematocrit maintained <25%
  Creation of biliary drainage Fluid management

Abbreviation: IVC, inferior vena cava.

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