Recovery And Intensive Care

The postoperative phase of care is characterized by careful monitoring for graft function, fluid replacement and electrolyte monitoring. Portal vein and hepatic arterial flow is also monitored by ultrasound. Some bleeding is not infrequent in the postoperative period but does not often require urgent re-operation. Progressive abdominal distention resulting in difficulty in ventilation or decreasing urine output may indicate that a return to the OR is indicated for evacuation of blood and clots. Some form of antithrombosis prophylaxis therapy is desirable. We use a heparin infusion at 10 units/kg/hour as prophylaxis against arterial thrombosis and replace drain output with fresh frozen plasma in infants to correct the hyper-coagulable state that may exist following transplantation.11

Ultrasound examination is carried out on the first postoperative day to examine arterial and portal venous flow. In the absence of satisfactory flow in either vessel, an immediate return to the operating room is indicated for revision of the vascular anastomoses. Arteriography is rarely necessary to confirm ultrasound findings. Vessels, particularly the portal vein can frequently be revised to restore satisfactory blood flow.12 Although the success of intervention in cases of arterial occlusion is less predictable, a substantial proportion of these vessels can be opened up with a combination of thrombolytic therapy in the OR, postoperative anticoagulation and careful revision of the anastomoses to exclude technical factors.13

Arterial hypertension in the ICU is common and can usually be managed by careful fluid management, diuretic therapy and calcium channel blockers. Pro

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