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Anesthetic management of a pediatric patient with pulmonary arteriovenous fistula undergoing liver transplantation - a case report

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Author(s)
Ho‐Jin LeeJung‐Man LeeChul‐Woo JungJiwon Lee
Keimyung Author(s)
Lee, Ji Won
Department
Dept. of Anesthesiology & Pain Medicine (마취통증의학)
Journal Title
Pediatric transplantation
Issued Date
2016
Volume
20
Issue
5
Keyword
anesthesialiver transplantationhepatopulmonary syndromepulmonary arteriovenous fistulapediatrics
Abstract
For patients with HPS who require anesthesia for a procedure, HPV should be maintained to prevent worsening hypoxemia. Here, the case of a 9‐yr‐old girl who was scheduled for a living donor liver transplantation is presented. The patient suffered from end‐stage liver disease with HPS due to biliary atresia, which contributed to the development of a diffuse pulmonary AVF. Consequently, anesthetic management of this patient involved two different types of pulmonary shunt. It is important to maintain HPV, not only to prevent worsening of the hypoxia caused by HPS but also to inhibit an increase in PVR that could cause an increase of shunt flow through the pathological fistula. A TIVA technique was performed, and a nitrous oxide inhaler was prepared in case of a possible increase in PVR during the reperfusion period. There were no adverse events during the operation. Thus, anesthesiologists should be aware of the pathophysiological status of HPS and its potential to progress to a pulmonary AVF in order to meticulously determine an anesthesia plan that accounts for the hypoxia and PVR that are associated with HPS.
Keimyung Author(s)(Kor)
이지원
Publisher
School of Medicine
Citation
Ho‐Jin Lee et al. (2016). Anesthetic management of a pediatric patient with pulmonary arteriovenous fistula undergoing liver transplantation - a case report. Pediatric transplantation, 20(5), 711–716. doi: 10.1111/petr.12716
Type
Article
ISSN
1397-3142
Source
https://onlinelibrary.wiley.com/doi/abs/10.1111/petr.12716
DOI
10.1111/petr.12716
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/32840
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Anesthesiology & Pain Medicine (마취통증의학)
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