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Indian Journal of Clinical Anaesthesia


Anesthetic management and perioperative outcome of infants with Biliary atresia: A retrospective review of 40 cases from a tertiary care pediatric institute in India


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Author Details: Anuradha Ganigara, Chandrika Y Ramavakoda, Bindu, Bhargavi Sanket, Vinay Jadhav, Jayalaxmi Sripathi

Volume : 3

Issue : 1

Online ISSN : 2394-4994

Print ISSN : 2394-4781

Article First Page : 62

Article End Page : 68


Abstract

Background:  Biliary atresia (BA) is a progressive and fatal obliterative cholangiopathy affecting 1 in 10,000 infants resulting in biliary cirrhosis and eventually death within the first two years of life. The first line of treatment is a surgical procedure known as Kasai’s portoenterostomy which aims to restore the forward flow of bile into the intestines. There is paucity of literature regarding perioperative anesthetic management of BA and its outcome. This review was thus specifically done to fill in the dearth with regard to anesthetic challenges and complications met during management of infants with BA undergoing Kasai’s procedure.
Materials and methods: Retrospective data of all infants diagnosed and operated for EHBA in our institute from 2011 to 2014 was collected. Perioperative data, anesthetic and surgical details including post operative course of these children were collected and analyzed.
Results: The highlights of our series were the delayed presentation of infants with BA at an average age of 85 days which indirectly prolonged the operative time. These infants in early stages of cirrhosis had higher requirements of crystalloid and blood component therapy.  Intraoperatively, a decrease in blood pressure was also reflected in the R wave amplitude of ECG which signals further research in the direction of non invasive hemodynamic monitoring in infants. Of significance was the finding of normal intraoperative blood glucose values in infants with EHBA and thus inadvertent dextrose supplementation in all infants with liver dysfunction needs to be avoided. Multimodal analgesia in the form of intravenous opioids, paracetamol, tramadol and judicious local anesthetic infiltration can be used to tackle perioperative pain.
Conclusions: In conclusion, when faced with anesthetizing infants with EHBA, the anesthesiologist needs to pay attention to the preoperative assessment like age of presentation, severity of the liver dysfunction and associated congenital and co morbid conditions like anemia and coagulopathy. Goals of anesthetic management would include meticulous maintenance of euvolemia, euthermia, euglycemia and provision of adequate perioperative analgesia and anesthesia.

Keywords:
Infants, Biliary atresia, Anesthesia, Perioperative care, Outcome, Implications