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[Anesthesia for a pediatric multivisceral transplant].
P Sanabria Carretero1, M A Herranz Ortega, E Rodríguez Pérez
1Servicio de Anestesia-Reanimación Pediátrica, Hospital Infantil Universitario, "La Paz", Madrid. psanabria@tiscali.es
Revista Espanola De Anestesiologia Y Reanimacion
|April 10, 2004
Summary
A complex multivisceral and kidney transplant successfully treated a 15-year-old with short bowel syndrome. The surgery managed severe complications from long-term parenteral nutrition, restoring organ function.
Area of Science:
- Transplantation surgery
- Gastroenterology
- Nephrology
Background:
- A 15-year-old female presented with short bowel syndrome secondary to chronic intestinal pseudo-obstruction and kidney failure.
- She required 5 years of parenteral nutrition, leading to severe complications including sepsis, thrombosis, liver dysfunction, bone marrow failure, and malnutrition.
Observation:
- The patient underwent a 15-hour multivisceral (stomach-duodenum-jejunum-ileum-pancreas-liver) and kidney transplant.
- The surgery was complicated by hypothermia post-revascularization, requiring significant blood product and crystalloid replacement.
- Biochemical and hemodynamic parameters remained stable, despite transient hypernatremia, hyperglycemia, and lactic acidosis.
Findings:
- The anesthetic management focused on preoperative optimization for chronic parenteral nutrition complications, hypothermia prevention, electrolyte and acid-base correction, reperfusion syndrome management, and hemodynamic support.
- Successful graft revascularization and circulatory homeostasis were achieved.
Implications:
- This case highlights the feasibility of complex multivisceral and kidney transplantation in pediatric patients with short bowel syndrome and associated organ failure.
- Careful anesthetic planning and management are crucial for addressing the unique challenges and complications in such high-risk surgical cases.