Abstract:

Objective To retrospectively summerize the anesthetic characteristics in 85 infants and children undergoing living related partial liver transplantation admitted to Tianjin First Center Hospital from January 2010 to October 2013. Methods 85 cases of the American Society of Anesthesiologists (ASA) HI or IV elective pro-donor liver transplantation in children, into the operating room oxygen mask, upper extremity venous channels were open in the ward. Intravenous injection of ketamine 0.15-0.20 mg/kg, midazolam 0.10-0.15 mg/kg, fentany 2-5 pg/kg and vecuronium 0.8-1.0 mg/kg induction of anesthesia. Preoperative intravenous access without children section, intramuscular ketamine 5—10 mg/kg, sevoflurane, open upper extremity venous channels ; intermittent intravenous fentanyl 1-3 pg/kg, vecuronium 0.3-0.5 mg/kg, inhalation of 1.0% to 1.5% sevoflurane anesthesia. Intravenous infusion of dopamine 1-5 pg/ (kg ? min), nitroglycerin 0.2-0.5 (kg ? min) or intravenous epinephrine 5—20 pg or 40-100 jxg of phenylephrine to maintain loop stability. The temperature was maintained with heating devices such as heating bed, heating blanket and fluid warming. Heart rate (HR), electrocaradiogram (ECG), pulse oxygen saturation (SpO₂), mean arterial pressure (MAP), central venous pressure(CVP)were monitored.Blood gas analysis〔 pH value, arterial partial pressure of oxygen (Pa0₂), arterial partial pressure of carbon dioxide (PaC0₂), base excess (BE) J, blood K⁺, Ca" and glucose levels were determined. The prothrombin time, partial prothrombin time, activated partial prothrombin time and fibrinogen levels were also measured. Results Inferior vena cava occlusion time was 40-62 minutes. The durations of portal circulation interruption and surgery were 43-72 minutes, 240-500 minutes. 84 patients were discharged from the hospital. One patient died 6 days after operation because of acute rejection. There were severe pneumonia in 2 patients, and biliary fistula in 4 patients after operation. Conclusion Intraoperative insulation, smooth induction and maintenance of anesthesia, ultrasound guided internal jugular vein catheterization, perioperative hemodynamic stable, effective liver, kidney, heart protective measures to adjust monitor blood gas and electrolytes, coagulation function key management and immunosuppressant and fliers are key issues to ensure the success of pediatric liver transplantation.