title: Anesthesia care for living-related liver transplantation for infants and children with end-stage liver disease: report of our initial experience.
abstract: OBJECTIVE
  To describe our initial experience of the perioperative anesthetic care provided to pediatric recipients during living-related liver transplantation.
  
  
  METHODS
  Cohort review of the perioperative anesthetic care for living-related liver transplantation.
  
  
  METHODS
  Tertiary referral and postgraduate teaching hospital.
  
  
  METHODS
  27 children (20 males, 7 females) with end-stage hereditary metabolic liver disease requiring living-related liver transplantation.
  
  
  METHODS
  Perioperative care was administered during living-related liver transplantation.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 microg 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesia and Intensive Care, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia. drdjurberg@hotmail.com
authors.forename: Hans
authors.initials: H
authors.lastname: Djurberg
authors.forename: Werner
authors.initials: W
authors.lastname: Pothmann Facharzt
authors.forename: Damien
authors.initials: D
authors.lastname: Joseph
authors.forename: David
authors.initials: D
authors.lastname: Tjan
authors.forename: Mehrun
authors.initials: M
authors.lastname: Zuleika
authors.forename: Stanley
authors.initials: S
authors.lastname: Ferns
authors.forename: Arshad
authors.initials: A
authors.lastname: Rasheed
authors.forename: David A Price
authors.initials: DA
authors.lastname: Evans
authors.forename: Atef
authors.initials: A
authors.lastname: Bassas
mesh_terms: D000759:Adjuvants, Anesthesia; D000328:Adult; D000771:Anesthesia, Intravenous; D001279:Atracurium; D001656:Biliary Atresia / Q000150:complications; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005283:Fentanyl; D006008:Glycogen Storage Disease / Q000150:complications; D006801:Humans; D008107:Liver Diseases / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008874:Midazolam; D003473:Neuromuscular Nondepolarizing Agents
chemical_list: D000759:Adjuvants, Anesthesia; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D008874:Midazolam; D005283:Fentanyl