Anaesthesia for Biliary Atresia and Hepatectomy in Paediatrics

Overview

Journal Indian J Anaesth

Specialty Anesthesiology

Date 2013 Jan 8

PMID 23293387

Citations 6

Authors

Rebecca Jacob

Affiliations

Soon will be listed here.

Abstract

The scope of this article precludes an 'in depth' description of all liver problems and I will limit this review to anaesthesia for biliary atresia - a common hepatic problem in the very young - and partial hepatectomy in older children. I will not be discussing the problems of anaesthetising children with hepatitis, cirrhosis, congenital storage diseases or liver failure. Extrahepatic biliary obstruction is an obliterative cholangiopathy of infancy which is fatal if untreated. Diagnosis involves exclusion of other causes of neonatal jaundice and treatment involves a hepatico portoenterostomy carried out at the earliest. This is a review of current concepts in anaesthesia and postoperative management of neonates with extrahepatic biliary atresia. Anaesthesia for hepatic resection has seen great changes in recent times with the improvement in surgical techniques, technology and a better understanding of the underlying physiology. These are reviewed along with the problems of postoperative pain management.

Citing Articles

Perioperative comparison of whether the liver was lifted out of the abdominal cavity in Kasai surgery.

Xu K, Gao J, Chen X, Fang Y, Wu D, Lin Y Front Pediatr. 2025; 13:1549636.

PMID: 40051912 PMC: 11882850. DOI: 10.3389/fped.2025.1549636.

Effect of Dexmedetomidine Combined with Remifentanil on Emergence Agitation During Awakening from Sevoflurane Anesthesia for Pediatric Liver Surgery.

Wang Y, Liu C, Wang P, Li L, Feng W Ann Transplant. 2024; 29:e943281.

PMID: 38803088 PMC: 11143914. DOI: 10.12659/AOT.943281.

Liver Transplantation in a Child with Kartagener Syndrome: A Case Report.

Uludag Yanaral T, Karaaslan P, Uzunoglu E, Atalay Y, Tobias J Int Med Case Rep J. 2021; 14:295-299.

PMID: 34007221 PMC: 8123947. DOI: 10.2147/IMCRJ.S311843.

Comparative effect of desflurane and sevoflurane on liver function tests of patients with impaired hepatic function undergoing cholecystectomy: A randomized clinical study.

Soliman R, Yacoub A, Abdellatif M Indian J Anaesth. 2020; 64(5):383-390.

PMID: 32724246 PMC: 7286405. DOI: 10.4103/ija.IJA_168_20.

Anaesthetic Management of a Patient with Synchronous Kartagener Syndrome and Biliary Atresia.

Kendigelen P, Tutuncu A, Erbabacan S, Kaya G, Altindas F Turk J Anaesthesiol Reanim. 2016; 43(3):205-8.

PMID: 27366497 PMC: 4917192. DOI: 10.5152/TJAR.2015.94546.

References

Wong K, Fan A, Lan L, Lin S, Tam P . Effective antibiotic regime for postoperative acute cholangitis in biliary atresia--an evolving scene. J Pediatr Surg. 2004; 39(12):1800-2. DOI: 10.1016/j.jpedsurg.2004.08.027. View

Matot I, Scheinin O, Eid A, Jurim O . Epidural anesthesia and analgesia in liver resection. Anesth Analg. 2002; 95(5):1179-81, table of contents. DOI: 10.1097/00000539-200211000-00009. View

Khalil B, Perera M, Mirza D . Clinical practice: management of biliary atresia. Eur J Pediatr. 2009; 169(4):395-402. DOI: 10.1007/s00431-009-1125-7. View

Jones R, Moulton C, Hardy K . Central venous pressure and its effect on blood loss during liver resection. Br J Surg. 1998; 85(8):1058-60. DOI: 10.1046/j.1365-2168.1998.00795.x. View

Tan C, Davenport M, DRIVER M, Howard E . Does the morphology of the extrahepatic biliary remnants in biliary atresia influence survival? A review of 205 cases. J Pediatr Surg. 1994; 29(11):1459-64. DOI: 10.1016/0022-3468(94)90144-9. View

Schumann R, Zabala L, Angelis M, Bonney I, Tighiouart H, Carr D . Altered hematologic profiles following donor right hepatectomy and implications for perioperative analgesic management. Liver Transpl. 2004; 10(3):363-8. DOI: 10.1002/lt.20059. View

Bittmann S . Surgical experience in children with biliary atresia treated with portoenterostomy. Curr Surg. 2005; 62(4):439-43. DOI: 10.1016/j.cursur.2004.11.022. View

Ho A, Karmakar M, Cheung M, Lam G . Right thoracic paravertebral analgesia for hepatectomy. Br J Anaesth. 2004; 93(3):458-61. DOI: 10.1093/bja/aeh212. View

Murray D, Forbes R, Dull D, Mahoney L . Hemodynamic responses to nitrous oxide during inhalation anesthesia in pediatric patients. J Clin Anesth. 1991; 3(1):14-9. DOI: 10.1016/0952-8180(91)90200-7. View

10.

Wildhaber B, Coran A, Drongowski R, Hirschl R, Geiger J, Lelli J . The Kasai portoenterostomy for biliary atresia: A review of a 27-year experience with 81 patients. J Pediatr Surg. 2003; 38(10):1480-5. DOI: 10.1016/s0022-3468(03)00499-8. View

11.

Lentschener C, Ozier Y . Anaesthesia for elective liver resection: some points should be revisited. Eur J Anaesthesiol. 2002; 19(11):780-8. DOI: 10.1017/s0265021502001266. View

12.

Hatano Y, Murakawa M, Segawa H, Nishida Y, Mori K . Venous air embolism during hepatic resection. Anesthesiology. 1990; 73(6):1282-5. DOI: 10.1097/00000542-199012000-00036. View

13.

Kasai M, Watanabe I, Ohi R . Follow-up studies of long term survivors after hepatic portoenterostomy for "noncorrectible" biliary atresia. J Pediatr Surg. 1975; 10(2):173-82. DOI: 10.1016/0022-3468(75)90275-4. View

14.

Seefelder C, Lillehei C . Epidural analgesia for patients undergoing hepatic portoenterostomy (Kasai procedure). Paediatr Anaesth. 2002; 12(2):193-5. View

15.

Spahn D, Casutt M . Eliminating blood transfusions: new aspects and perspectives. Anesthesiology. 2000; 93(1):242-55. DOI: 10.1097/00000542-200007000-00035. View

16.

Kelly D, Davenport M . Current management of biliary atresia. Arch Dis Child. 2007; 92(12):1132-5. PMC: 2066090. DOI: 10.1136/adc.2006.101451. View

17.

Popovic L, Batinica S, Mestrovic T, Zupancic B, Antabak A, Petrunic M . The value of cholinesterase activity after Kasai operation. Pediatr Surg Int. 2003; 19(8):605-7. DOI: 10.1007/s00383-003-1054-x. View

18.

Shneider B, Brown M, Haber B, Whitington P, Schwarz K, Squires R . A multicenter study of the outcome of biliary atresia in the United States, 1997 to 2000. J Pediatr. 2006; 148(4):467-474. DOI: 10.1016/j.jpeds.2005.12.054. View

19.

Green D, Ashley E . The choice of inhalation anaesthetic for major abdominal surgery in children with liver disease. Paediatr Anaesth. 2002; 12(8):665-73. DOI: 10.1046/j.1460-9592.2002.00724.x. View

20.

Green D, Howard E, Davenport M . Anaesthesia, perioperative management and outcome of correction of extrahepatic biliary atresia in the infant: a review of 50 cases in the King's College Hospital series. Paediatr Anaesth. 2000; 10(6):581-9. DOI: 10.1111/j.1460-9592.2000.00579.x. View