Anesthetic Management of a Jehovah’s Witness Child for Repair of a Large Ventricular Septal Defect Involving Cardio-Pulmonary-Bypass.

Abstract: Surgical management of a Jehovah’s Witness child is medically and ethically challenging. Surgeries involving cardio-pulmonary-bypass are even more challenging as the need for requirement of blood transfusion could be higher. By modifying surgical techniques, charting out careful preoperative preparation, meticulous intraoperative and postoperative management, need for the blood transfusion can be avoided. In our case report we present a 15-month-old girl with Down’s syndrome and large inlet ventricular septal defect. She underwent pulmonary artery banding at the age of 4 months. The surgery was planned in two stages since the family was Jehovah’s Witnesses, and requested the avoidance of blood products. In this case report we will discuss in detail how the surgery was modified in two stages with pulmonary artery banding as the primary intervention rather than undertaking primary repair. We will also discuss the modifications in the cardio-pulmonary bypass circuits, and choices available intra-operatively to minimize the blood loss. The key to a successful outcome in this case was well thought out plan by the surgeon, hematologist, anesthesiologist and the perfusionist, which we will discuss in detail