Liu L, Chen P, Fang LL, Yu LN. Perioperative anesthesia management in pediatric liver transplant recipient with atrial septal defect: A case report. World J Clin Cases 2022; 10(29): 10638-10646 [PMID: 36312503 DOI: 10.12998/wjcc.v10.i29.10638]
Corresponding Author of This Article
Li-Na Yu, MD, Chief Doctor, Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou 310009, Zhejiang Province, China. zryulina@zju.edu.cn
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 16, 2022; 10(29): 10638-10646 Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10638
Perioperative anesthesia management in pediatric liver transplant recipient with atrial septal defect: A case report
Lan Liu, Pei Chen, Li-Li Fang, Li-Na Yu
Lan Liu, Li-Li Fang, Li-Na Yu, Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Pei Chen, Department of Anesthesiology, Hangzhou Women's Hospital, Hangzhou 310008, Zhejiang Province, China
Author contributions: Liu L and Chen P contributed to manuscript writing and editing, and data collection; Fang LL contributed to data analysis; Yu LN contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Supported byNatural Science Foundation of Zhejiang Province, No. LQ19C090006.
Informed consent statement: Informed written parental consent was granted to publish this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The CARE Checklist (2016) was consulted and applied to the drafting of this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Na Yu, MD, Chief Doctor, Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou 310009, Zhejiang Province, China. zryulina@zju.edu.cn
Received: April 14, 2022 Peer-review started: April 14, 2022 First decision: June 16, 2022 Revised: July 13, 2022 Accepted: September 7, 2022 Article in press: September 7, 2022 Published online: October 16, 2022
Abstract
BACKGROUND
Preoperative conditions in pediatric liver transplant recipients are understandably complex. Compared with adults, children have lesser compensatory abilities and demand greater precision during procedural executions. In the setting of end-stage liver disease, the heightened perioperative risk of coexistent cardiovascular pathology may impact graft survival as well. Requirements for anesthesia and perioperative management are thus more rigorous, calling for individualized treatments that reflect specific cardiovascular constraints and proposed surgical plans.
CASE SUMMARY
Reports of perioperative anesthesia management and liver transplant prognostication in pediatric patients with concurrent atrial septal defects are scarce. Herein, we detail the course of liver transplantation in a child with dual afflictions, focusing on perioperative anesthesia management and the important contributions of the anesthesiologist (pre- and perioperatively) to a positive therapeutic outcome, despite the clinical hurdles imposed.
CONCLUSION
Children with atrial septal defects bear substantially more than customary perioperative risk during orthotopic liver transplants, given their compromised cardiopulmonary reserves and functional states. Comprehensive preoperative cardiovascular assessments, including use of agitated-saline contrast echocardiography (to characterize intracardiac shunting) and multidisciplinary deliberation, may offer insights into structural cardiac pathophysiologic effects and transplant-related hemodynamic changes that impact new grafts. At the same time, active and effective monitoring and other measures should be taken to maintain hemodynamic stability in the perioperative period, avoid entry of bubbles into the circulation, and ease congestion in newly grafted livers. Such efforts are crucial for transplantation success and graft survival.
Core Tip: Children with atrial septal defects bear substantially more than customary perioperative risk during orthotopic liver transplants. Although perioperative anesthesia management must reconcile individual cardiovascular constraints with proposed surgical plans, published reports offering necessary guidance are scarce. Herein, we address this complex scenario, focusing on issues of perioperative anesthesia management. Comprehensive preoperative cardiovascular assessments, with multidisciplinary input, may offer insights into structural cardiac pathophysiologic effects and transplant-related hemodynamic changes that impact new grafts. Active, effective hemodynamic monitoring and other measures are also essential during the perioperative period to ensure transplantation success and graft survival.
