Premium
L/I‐10
Anesthetic management of pediatric living related liver and small bowel transplants
Author(s) -
CampiseLuther R.
Publication year - 2006
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2006.00577_3_10.x
Subject(s) - medicine , short bowel syndrome , parenteral nutrition , liver transplantation , intestinal failure , surgery , cholestasis , perfusion , intensive care medicine , transplantation , anesthesia , gastroenterology
Living related liver and small bowel transplants, in combination or staged, are now considered an acceptable therapy for children with short gut syndrome who do not tolerate parenteral nutrition and suffer from liver dysfunction and portal hypertension secondary to cholestasis. The anesthetic management of a pediatric living related liver and small bowel transplant is very challenging. Preoperatively, the focus is on the extensive preparation needed for these cases. Intraoperatively, fluid management requires maintenance of a delicate balance between low CVP to prevent venous congestion of the transplant and adequate blood pressure to maintain perfusion, especially during the reperfusion phase. Monitoring the coagulation status and platelets is important, in order to be able to react appropriately to uncontrollable bleeding; however, overcorrection, which can lead to hepatic or mesenteric artery thrombosis and graft failure, should not be risked. Temperature control is crucial in children independent of the surgical procedure, but poses a special challenge in light of large volume shifts, cold transplanted organs, and large surface area exposure. Fluctuation in glucose levels, acid‐base status, and electrolytes have to be anticipated and treated. Postoperatively, these children have to be monitored in the ICU and cared for in a similar manner as intraoperatively. The team has to be prepared for emergent reexploration for complications, e.g., bleeding, at any time. These are some of the considerations that demonstrate the complexity of the anesthetic care of these children. References: Socol E. et al. Liver and intestinal transplantation in children; JPGN Vol. 35 (2) Supplement; Aug. 2002. Gregory GA. Pediatric Anesthesia, 4 th Edition, p. 541‐567, Churchill/Livingston 2002. Borland LM. Anesthesia for organ transplantation in children. Int Anesthesiol Clin 23:173, 1985.