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

Study Objective: To describe our initial experience of the perioperative anesthetic care provided to pediatric recipients during living-related liver transplantation. Design: Cohort review of the perioperative anesthetic care for living related liver transplantation. Setting: Tertiary referral and postgraduate teaching hospital. Patients: 27 children (20 males, 7 females) with end-stage hereditary metabolic liver disease requiring living related liver transplantation. Intervention: Perioperative care was administered during living-related liver transplantation. Measurements: 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. Main Results: During a 30-month period, 2 7 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 mug 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. Conclusion: Total TV 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. (C) 2003 by Elsevier Science Inc.