Successful Anesthesia Management of Pediatric Living Donor Liver Transplant With Mild Bilateral Pulmonary Artery Stenosis Due to Alagille Syndrome: A Case Report.

Alagille syndrome is an autosomal-dominantinherited disease characterized by intrahepatic bile duct involvement, congenital heart disease, eye anomalies, skeletal and central nervous system involvement, kidney anomalies, and facial appearance. Liver transplant is the only treatment option for patients with end-stage liver disease and Alagille syndrome. Bilateral peripheral pulmonary artery stenosis is a contraindication for liver transplant due to high mortality, and the decision for liver transplant in patients with bilateral peripheral pulmonary artery stenosis is extremely challenging for anesthesiologists andtransplant surgeons.Wepresent a 2-year-oldfemale patient with successful anesthetic management of a pediatric living donor liver transplant with mild bilateral pulmonary artery stenosis, mild aortic stenosis, and mitral regurgitation due to Alagille syndrome. Anesthesiologists should know the underlying pathophysiological condition and perform a comprehensive preoperative evaluation to determine the correct anesthesia plan in patients with Alagille syndrome who will undergo liver transplants to treat multiple system disorders. Successful perioperative management of Alagille syndrome requires effective communication and collaboration between specialists through a multidisciplinary team approach.

Effects of caloric and nutrient content of oral fluids on gastric emptying in volunteers: a randomised crossover study.

BACKGROUND: Previous studies demonstrated conflicting results regarding the determinants of gastric emptying for fluids. Our aim was to compare gastric emptying times of fluids with different caloric and nutrient content. METHODS: Healthy adult volunteers underwent gastric ultrasound assessment for 4 h after consuming beverages with different caloric and nutrient content using a crossover design (oat drink with 3% fat [310 kcal], mango juice [310 kcal], oat drink with 0.5% fat [185 kcal], and blackcurrant juice [175 kcal]). Gastric emptying time, gastric content volume, and the area under the curve (AUC) of gastric content volume-time profiles were calculated. RESULTS: Eight females and eight males completed the study protocol. The mean (sd) gastric emptying times were 89 (32) min for blackcurrant juice, 127 (54) min for oat drink with 0.5% fat, 135 (36) min for mango juice, and 152 (40) min for oat drink with 3% fat. Gastric emptying times were slower for oat drink with 3% fat (P=0.007) and mango juice (P=0.025) than for blackcurrant juice. At 1 h after ingestion, gastric content volume was greater for mango juice (P=0.021) and oat drink with 3% fat (P=0.003) than for blackcurrant juice. The AUC was greater for oat drink with 3% fat than mango juice (P=0.029), oat drink with 0.5% fat (P=0.004), and blackcurrant juice (P=0.002), and for mango juice than blackcurrant juice (P=0.019). CONCLUSIONS: Caloric and nutrient content significantly affected gastric emptying times. A high-calorie fruit juice (mango) exhibited delayed emptying times compared with a low-calorie fruit juice (blackcurrant). CLINICAL TRIAL REGISTRATION: ISRCTN17147574.

Anaesthesia management for liver transplantation: A narrative review.

Orthotopic liver transplantation is the definitive standard treatment for end-stage liver disease. Orthotopic liver transplantation anaesthesia management is a complex procedure that requires a multidisciplinary team approach. Understanding the complex pathophysiology of end-stage liver disease and its complications in the affected systems is essential for proper anaesthesia management in orthotopic liver transplantation. Orthotopic liver transplantation is a dynamic process, and preoperative optimisation is essential in these patients. Therefore, anaesthesiologists should focus on rapidly fluctuating physiology, haemodynamics, metabolic, and coagulation status in the anaesthesia management of these patients. Perioperative care and anaesthesia for orthotopic liver transplantation can be divided into preoperative evaluation, anaesthesia induction and management, dissection, anhepatic, neo-hepatic, and postoperative care, with essential anaesthetic considerations at each point. Considering the clinical situation, haemodynamic changes, misapplications, knowledge, attitude, and multimodal and multidisciplinary approach are vital in anaesthesia and the perioperative period. In our review, in line with the literature, we aimed to present the perioperative and anaesthesia management in orthotopic liver transplantation patients.

Relationship Between Postoperative Acute Kidney Injury and Early Extubation After Pediatric Liver Transplant.

OBJECTIVES: Postoperative acute kidney injury after pediatric liver transplant is a serious complication with considerable short-term and long-term consequences. We hypothesized that incidence of postoperative acute kidney injury after pediatric liver transplant is lower among patients extubated early after surgery in the operating room. MATERIALS AND METHODS: In this retrospective cohort study, we reviewed the medical records of all patients aged <18 years who underwent liver transplant from January 2012 to December 2020. Early extubation was defined as extubation in the operating room. Children were divided into 2 groups: those who were extubated in the operating room and those who were extubated in the intensive care unit. RESULTS: A total of 132 pediatric liver transplant recipients were analyzed. The mean age of transplant was 58.2 ± 60.1 months, and 54.5% were male recipients. Early immediate tracheal extubation in the operating room was performed in 86 patients (65.2%). Postoperative acute kidney injury was seen in 24 children (18.2%) of which 15 (11.4%) had stage 1 acute kidney injury, 8 (6.1%) had stage 2, and 1 (0.8%) had stage 3. There was no statistically significant difference between the 2 groups regarding development of acute kidney injury (18.6% vs 17.4%; P > .05). Compared with patients who were not extubated in the operating room, the need for an open-abdomen procedure (76.9% vs 23.1%; P = .001) was significantly higher in patients who were extubated in the operating room. Durations for length of stay in the intensive care unit and hospital were significantly shorter in patients who were extubated in the operating room (P < .001). CONCLUSIONS: Our results showed that early extubation was performed in nearly two-thirds of our cohort. There was no association between early extubation and development of acute kidney injury among pediatric liver transplant recipients.