[Anesthetic management for urgent endoscopy in a child with heterotopic liver transplant]

A 6-year-old boy with heterotopic liver transplant underwent urgent endoscopy under general anesthesia because of bloody stool. He was taking cyclosporin as an immunosuppressant. His hepatic function was normal and no side effects of cyclosporin were observed. Preoperative blood transfusion was performed because of severe anemia. Anesthesia was induced with midazolam 2 mg, ketamine 20 mg and fentanyl 0.05 mg, and maintained with addition of midazolam and ketamine. We did not use any inhalation anesthetics to avoid postoperative hepatic dysfunction. The endoscopy was successfully performed and the postoperative course was uneventful. We conclude that preanesthetic evaluation of immunosuppressant state and the hepatic function of transplanted liver is important for anesthetic management of a patient with heterotopic liver transplant.