Characteristics Of Anesthesia Management In Pediatric Parental Liver Transplantation

Objective To retrospectively analyze the anesthesia management of 35pediatric patients with parental liver transplantation in our hospital.Methods 35 patients with end-stage liver disease,18 males and 17 females,aged from 5 months to 9 years,received liver transplantation.Anesthesia induction was conducted by intravenous injection of 2?g/kg fentanyl,2.5⁴.0mg/kg propofol and 0.2mg/kg cistracurium.Children without peripheral venous access were given 4%⁸%sevoflurane inhalation and sedation followed by open peripheral venous access and subsequent induction.Anesthesia was maintained by combined anesthesia with intravenous infusion of2%³%sevoflurane,remifentanil 0.1⁰.2?g·kg^-1·min^-1,propofol 3¹2mg·kg^-1·h^-11 and cialatracurium 1³?g·kg^-1·min^-1.Records of children,30min after anesthesia,preoperative portal vein blocking immediately before and after blocking instantly,without liver period 30 min,the portal open instantly,the new period of 1 h and finish the heart rate?HR?,mean arterial pressure?MAP?,temperature?T?,pulse pressure variation degrees?PPV?,central venous pressure?CVP?,electrolytes,blood glucose?Glu?,in case such as lactic acid?Lac?.The postoperative ICU retention time,mechanical ventilation time,vital signs and blood gas results three days after surgery,and liver and kidney function in the first,third and seventh days after surgery were tracked.Results Compared with 30min after anesthesia,DBP decreased significantly at 1h in the new liver stage,and increased to 30min after anesthesia at the end of surgery?P<0.05?.Compared with 30min after the non-hepatic stage,the heart rate decreased significantly immediately after reperfusion and 1h after the new liver stage,and the SDP increased significantly after surgery?P<0.01?.At the beginning of the hepat-free stage,the body temperature of the children began to drop gradually,and then dropped further after reperfusion,and the body temperature of the new liver stage began to rise gradually?P<0.01?.There were no statistically significant differences in MAP,PPV and CVP at each intraoperative time point.After entering the hepat-free phase,the urine volume decreased significantly,and compared with the hepat-free phase,the urine volume in the new liver phase increased significantly,with a statistically significant difference?P<0.01?,but there was no statistically significant difference between the pre-hepat-free phase and the hepat-free phase?P>0.05?.Compared with 30min after anesthesia,the BE value immediately after reperfusion decreased significantly,and Na+gradually increased from before occlusion to after surgery?P<0.01?.Glu was significantly increased immediately after reperfusion and at 1h in the new liver stage,and decreased after the surgery,but it was still higher than the level 30min after anesthesia?P<0.01 or P<0.05?.Compared with the moment before occlusion,the level of K+in 1h decreased gradually?P<0.01 or P<0.05?.Lac level began to gradually increase before occlusion,and further increased immediately after reperfusion,and Lac level began to gradually decrease from the new liver stage to the completion of surgery?P<0.01?.The oxygenation index immediately before occlusion,30min without liver stage,and immediately after reperfusion and postoperative oxygenation index were all higher than 30min after anesthesia,among which the oxygenation index immediately after reperfusion increased to the highest and then gradually decreased?P<0.01 or 0.05?.There were no statistically significant differences in the pco2,central venous oxygen saturation,and arteriovenous oxygen saturation at each time point.There was no statistically significant difference in creatinine before and after surgery,and no statistically significant difference in urine volume three days after surgery.Compared with preoperation,SDP,DBP and MAP in the three days after operation were higher than those before operation,and the oxygen saturation of finger pulse decreased gradually,with statistically significant difference?P<0.05?.There was no significant difference in HR and T before and three days after surgery?P>0.05?.Compared with the postoperative ratio,pCO₂ of blood gas for three consecutive days after surgery was greater than the postoperative result and gradually increased,pO₂,oxygenation index and Lac value were lower than the postoperative result,and further decreased on the second day after surgery and then gradually increased on the third day?P<0.01?.There was no statistically significant difference in blood gas pH and BE values between postoperative and postoperative days?P>0.05?.Compared with the first day after surgery,BE value significantly increased,Na⁺level gradually decreased,K⁺level gradually increased,Lac level significantly decreased on the second day and slightly increased on the third day,but still lower than the level on the first day after surgery?P<0.01 or 0.05?.There were no significant differences in pH,pCO₂,pO₂,PaO₂/FiO₂ and BE values between the two groups on the first day after surgery?P>0.05?.Conclusion 1.Anesthesia management of pediatric liver transplantation has its particularity.Adequate preparation for preoperative visit and evaluation,stable intraoperative hemodynamic stability,intraoperative thermal insulation,and correction of internal environment disorder are the keys to the success of liver transplantation.2.The immediate vital signs and internal environmental changes of reperfusion were the most dramatic,requiring close monitoring and timely treatment.