Anesthesia for living-donor liver transplantation: Comparison of 20 adult and 10 pediatric patients [Canli donörden karaciger transplantasyonu anestezisi sonuçlari: 20 yetişkin 10 pediyatrik hastanin karşilaştirilamsi]

Twenty adult and ten pediatric patients undergoing Living-Donor Liver Transplantation were evaluated in terms of perioperative anesthetic courses. Recipients had an anesthesia consisting of tiopental Na, fentanyl citrate/remifentanil, oxygen/air with isoflurane or midazolam/propofol and vecuronium/cisatracurium. The duration of the anesthesia and anhepatic periods of the pediatric patients were shorter compared to the adult group (541±106 vs 649±149 minutes and 47±12 vs 89±54 minutes, p<0.05). During the anhepatic periods of the operations cardiac output decreased 30% in adults vs 14% in pediatric patients (p>0.05), while a 38% increase in SVR values of adult cases and 74% increase in pediatric cases was observed (p<0.05). Postreperfusion syndromes were seen in two pediatric (20%) and five (25%) adult patients necessitating ephedrine boluses. Perioperative blood and fresh frozen plasma needs of the adult and pediatric groups were similar (Blood, 0.10±0.08 vs 0.11± 0.07 U kg-1; TDP, 0.11±0.07 vs 0.12±0.07 U kg-1, respectively p>0.05). Calcium gluconate requirement in pediatric patients was greater than the adult group (1.20±1.23 vs 0.62±0.78 mEq kg-1, p<0.05). Survival rates of the two patient groups was 70% in adults vs 60% in pediatric patients. In conclusion, immediate replacement therapies according to the laboratory and hemodynamic measurement performed at certain appropriate operation period are important in maintaining a stable peroperative course in both patient groups. Pediatric cases of smaller ages can be managed without monitoring with a pulmonary artery catheter. Use of proper anesthetic agents and stable hemodynamics during the operations can lead to extubation of the selected patients in the operating room and earlier recovery