Anesthetic Considerations for the Child Undergoing Transplantation
Since the first kidney transplant, advancements in the care of solid organ transplant patients have included advancements in the intraoperative anesthetic care. Anesthesiologists specializing in the care of children undergoing solid organ transplant are integral members of the transplant team. Their experience and knowledge are an important part of the initial evaluation phase, the preoperative planning, intraoperative care, and postoperative care of this patient population.
Preoperatively, the pediatric transplant anesthesiologist performs an in-depth examination and evaluation of each patient. The combination of past medical history and current medical conditions helps to identify possible intraoperative challenges and plan for the safest possible intraoperative course.
Intraoperatively, the anesthesiologist is responsible for the overall care of the patient and is quick to respond to both the expected as well as unexpected changes in the patient’s medical condition. Each type of transplant has different stages during the operation. Close communication and a familiar operating room team are needed to ensure a smooth transition between stages as well as rapid response to unexpected events that are encountered during these difficult surgeries.
Postoperatively, the pediatric transplant anesthesiologist is an important part of transitioning the patient from an anesthetized state in the operating room to the team that will care for them during their recovery. Plans for pain control, respiratory support, and ongoing hemodynamic support are made and initiated by the anesthesiologist in the operating room.
KeywordsAnesthesiology Liver Transplant Kidney Transplant Living-related donor Biliary Atresia Kasai hepatoportoenterostomy
- American Society of Anesthesiologists Committee (2011) Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on standards and practice parameters. Anesthesiology 114:495–511CrossRefGoogle Scholar
- Gad EH, Abdelsamee MA, Kamel Y (2016) Hepatic arterial and portal venous complications after adult and pediatric living donor liver transplantation, risk factors, management and outcome (a retrospective cohort study). Ann Med Surg 8:28–39. https://doi.org/10.1016/j.amsu.2016.04.021 CrossRefGoogle Scholar
- Wan S, Roberts MA, Mount P (2016) Normal saline versus lower-chloride solutions for kidney transplantation. Cochrane Database Syst Rev:CD010741. https://doi.org/10.1002/14651858.CD010741.pub2