Anesthesia care for living-related liver transplantation for infants and children with end-stage liver disease: report of our initial experience

To describe our initial experience of the perioperative anesthetic care provided to pediatric recipients during living-related liver transplantation. Cohort review of the perioperative anesthetic care for living-related liver transplantation. Tertiary referral and postgraduate teaching hospital. 27 children (20 males, 7 females) with end-stage hereditary metabolic liver disease requiring living-related liver transplantation. Perioperative care was administered during living-related liver transplantation. The major intraoperative physiologic events and concerns are described, as well as the anesthesia technique for pediatric living-related liver transplantation anesthesia. Intraoperative changes in physiologic parameters and the intraoperative requirements in our series are also reported. During a 30-month period, 27 children (20 males and 7 females) were scheduled for transplantation with an hepatic graft from a living-related donor. Twenty-six children received a graft from a living-related donor, and one was retransplanted with a cadaveric graft because of graft failure, and one child received a cadaveric graft because of the lack of a suitable donor. All patients received intravenous (IV) anesthesia with fentanyl, midazolam, and cisatracurium, and were ventilated with oxygen/air. Mean induction and presurgical preparation time was 1.18 hours, with a surgical time of 6.55 hours. All but one patient was extubated on the evening of the operating day after receiving a mean dose of 8.67 μg kg –1 hr –1 of fentanyl and a mean dose of 0.124 mg kg –1 hr –1 midazolam. The need for crystalloid infusion was 24.0 mL kg –1 hr –1, fresh frozen plasma (FFP)16.63 mL kg −1 hr −1, and red blood cells 7.98 mL kg –1 hr –1. There was no mortality and no anesthetic-related morbidity in our series. Total IV anesthesia with fentanyl, midazolam, and cisatracurium, after preoperative optimization, is a well-tolerated approach for children undergoing living-related liver transplantation and offers quick recovery. This anesthetic technique was aimed at minimizing the effects on the cardiovascular system, and also any consequences related to the possible occurrence of a reperfusion syndrome. Fluid balance was aimed at optimizing flow through the hepatic graft and preventing thrombosis of vascular anastomoses.