• Hans Djurberg, Werner Pothmann Facharzt, Damien Joseph, David Tjan, Mehrun Zuleika, Stanley Ferns, Arshad Rasheed, David A Price Evans, and Atef Bassas.
• Department of Anesthesia and Intensive Care, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia. drdjurberg@hotmail.com
• J Clin Anesth. 2002 Dec 1;14(8):564-70.

Study ObjectiveTo describe our initial experience of the perioperative anesthetic care provided to pediatric recipients during living-related liver transplantation.DesignCohort review of the perioperative anesthetic care for living-related liver transplantation.SettingTertiary referral and postgraduate teaching hospital.Patients27 children (20 males, 7 females) with end-stage hereditary metabolic liver disease requiring living-related liver transplantation.InterventionPerioperative care was administered during living-related liver transplantation.MeasurementsThe 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 ResultsDuring 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.ConclusionsTotal 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.

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