Bispectral Index™ variation during living donor liver transplantation in a child with hepatic encephalopathy: a case...

Area of Science:

• Pediatric critical care medicine
• Neurophysiology
• Transplantation surgery

Background:

• Neurological assessment in pediatric acute liver failure (ALF) can be challenging.
• The utility of Bispectral Index (BIS) monitoring for evaluating neurological function in pediatric ALF patients remains unclear.
• Hepatic encephalopathy (HE) is a common complication of ALF, significantly impacting neurological status.

Purpose of the Study:

• To investigate the effectiveness of perioperative Bispectral Index (BIS) monitoring in a pediatric patient with acute liver failure (ALF) and hepatic encephalopathy (HE).
• To describe changes in BIS values during and after liver transplantation (LT) in a pediatric patient.
• To evaluate BIS monitoring as a potential indicator of neurological recovery post-LT.

Main Methods:

• Case presentation of a 6-year-old comatose girl with ALF and HE.
• Continuous electroencephalography (EEG) revealed slow waves, indicating severe encephalopathy.
• Intraoperative BIS monitoring during emergency liver transplantation (LT), with analysis of values before and after reperfusion.

Main Results:

• Pre-reperfusion BIS values were low, consistent with severe hepatic encephalopathy (HE).
• Post-reperfusion, BIS values increased and showed greater variability, suggesting improved brain function.
• The patient was discharged with no neurological sequelae, correlating with improved BIS monitoring trends.

Conclusions:

• Low BIS values likely reflect the severity of HE in pediatric ALF.
• Improvement in BIS values and waveform post-LT may indicate successful graft function and neurological recovery.
• BIS monitoring shows promise as a valuable tool for assessing neurological status and recovery in pediatric liver transplant recipients.