Anesthetic Considerations

The anesthesiologist must have a good understanding of pediatric anesthesia and the operation. Compared to adults, children have increased surface area to mass ratio and lose heat rapidly when anesthetized and unclothed. To avoid hypothermia, the room, inhalational anesthetic, IV fluids, blood products, and child should be actively warmed. In small children, the graft requires a large portion of the circulating blood volume. To prevent hypotension and ensure immediate graft perfusion, the CVP is raised to 15 before unclamping. Unclamping washes preservation solution from the graft and acidotic, hyperkalemic blood from the lower body into the circulation. To prevent systemic acidosis and arrhythmias, 1 mEq/kg of sodium bicarbonate is given before unclamping and the anesthesiologist stands ready to treat arrhythmias. Finally, immediate graft function leads to large urinary losses of fluid and electrolytes. These losses are measured and replaced intraoperatively.

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