Long-term outcome of combined radiologic and surgical strategy for the management of biliary complications after pediatric liver transplantation.

Objectives: We aimed to analyze the risk factors for management failure of BC after pediatric liver transplantation (pLT) by retrospectively analyzing primary pLT performed between 1997 and 2018 (n = 620 patients).

Results: In all, 117/620 patients (19%) developed BC. The median (range) follow-up was 9 (1.

Biliary drainage surgery before or after 3 months of life versus primary liver transplantation in children with biliary atresia: comparative cohort study.

Background: Early biliary drainage surgery (BDS; Kasai) is associated with longer transplant-free survival in biliary atresia. However, evidence is lacking on whether an age limit can be established at which liver transplantation should be performed as first-line treatment for children with a delayed diagnosis of biliary atresia. The aim of the current study was to compare the outcome of a large cohort of children with biliary atresia who underwent BDS after 90 days of life with those who underwent early BDS (before 90 days) and those who did not receive BDS and were directly referred for primary liver transplantation.

Epidemiology and complications of anaesthesia in the French centres that participated to NECTARINE: A secondary analysis.

Introduction: Neonatal and infant anaesthesia are associated with a high risk of perioperative complications. The aim of the current study was to describe those risks in France using the French data from the NECTARINE study.

Material And Methods: Data from the French centres that participated to the NECTARINE study were analysed.

Long-term outcome of liver transplantation in childhood: A study of 20-year survivors.

We report the results of a study of survival, liver and kidney functions, and growth with a median follow-up of 24 years following liver transplantation in childhood. From 1988 to 1993, 128 children underwent deceased donor liver transplantation (median age: 2.5 years).

Comparison of monitoring performance of bioreactance versus esophageal Doppler in pediatric patients.

Background And Aims: Cardiac output (CO) monitoring and goal-directed therapy during major abdominal surgery is currently used to decrease postoperative complications. However, few monitors are currently available for pediatric patients. Nicom(®) is a noninvasive CO monitoring technique based on the bioreactance principle (analysis of frequency variations of a delivered oscillating current traversing the thoracic cavity).

Development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients: the VPOP score.

Background: Few data are available in the literature on risk factors for postoperative vomiting (POV) in children.

Objective: The aim of the study was to establish independent risk factors for POV and to construct a pediatric specific risk score to predict POV in children.

Methods: Characteristics of 2392 children operated under general anesthesia were recorded.

Experience with endoscopic management of high-risk gastroesophageal varices, with and without bleeding, in children with biliary atresia.

Background & Aims: Biliary atresia, the most common cause of childhood cirrhosis, increases the risks for portal hypertension and gastrointestinal bleeding. We report the results from a single-center study of primary and secondary prophylaxis of bleeding in children with portal hypertension and high-risk varices.

Methods: We collected data from 66 children with major endoscopic signs of portal hypertension, including grade 3 esophageal varices or grade 2 varices with red wale markings and/or gastric varices, treated consecutively from February 2001 through May 2011.

General anesthesia for intussusception reduction by enema.

Objectives: Intussusception is the most frequent cause of bowel obstruction in children. Although enema is usually used as the initial treatment, surgery may be required in more than 50% of patients. General anesthesia (GA) has been suggested to increase the rate of enema success.

Outcome of central hepatectomy for hepatoblastomas.

Background/purpose: Central hepatoblastomas (CHBL) involving liver segments (IV + V) or (IV + V + VIII) are in contact with the portal bifurcation. Their resection may be achieved by central hepatectomy (CH) with thin resection margins on both sides of the liver pedicle, by extended right or left hepatectomy with thin resection margins on one side, or by liver transplantation with thick free margins. The aim of this study is to assess the operative and postoperative outcome of CH for hepatoblastoma.

Human herpesvirus-6 infection: a prospective study evaluating HHV-6 DNA levels in liver from children with acute liver failure.

The aim of this prospective study was to investigate the role of HHV-6 infection in children with acute onset of liver failure using real-time quantitative PCR. Twenty-three children (median age, 24 months) were included: 6 cases of fulminant hepatic failure of undetermined cause (group 1); 4 cases of fulminant hepatic failure of recognized cause (group 2); 3 cases of acute decompensation of chronic liver disease (group 3); and 10 cases of chronic liver disease (group 4). HHV-6 genomic DNA was detected and quantified using real-time PCR in plasma and livers obtained at the time of transplantation.

The transesophageal Doppler and hemodynamic effects of epidural anesthesia in infants anesthetized with sevoflurane and sufentanil.

Background: It is thought that pediatric epidural anesthesia (EA) provides hemodynamic stability in children. However, when compared with information relating to adults, little is known about the hemodynamic effects of epidural EA on cardiac output (CO) in infants.

Methods: Using transesophageal Doppler to monitor CO, we prospectively studied 14 infants <10 kg who were scheduled for abdominal surgery.

Paediatric caudal and epidural analgesia.

Purpose Of Review: Epidural blocks (caudal, lumbar or thoracic) are of common use in paediatric patients for special procedures such as open fundoplication as well as for postoperative analgesia. However, because neonates and infants have lower metabolic capacities and specific anatomy as compared to adults, the dose of local anaesthetics and the way of their administration need careful attention.

Recent Findings: Recent pharmacokinetic studies have more precisely identified the differences in pharmacokinetics between age groups, and between local anaesthetic agents.

[Local anaesthetics: what can the pure S enantiomers contribute?].

The use of levobupivacaine and of ropivacaine may increase the safety of regional anaesthesia. These pure enantiomers have similar pharmacokinetic properties as those of the racemic mixtures. However, they are less cardiotoxic than the racemic mixtures, especially at the high heart rate usually encountered in infants.

Tolerance and analgesic efficacy of a new i.v. paracetamol solution in children after inguinal hernia repair.

Background: A new intravenous (i.v.) formulation of paracetamol and propacetamol (prodrug of paracetamol) were compared to determine tolerance and relative analgesic efficacy during the first 6 h after inguinal hernia repair performed under general anesthesia combined with ilioinguinal block in children.

Long-term outcome of pediatric liver transplantation for biliary atresia: a 10-year follow-up in a single center.

The aim of this study was to review our experience in orthotopic liver transplantation (OLT) for biliary atresia (BA) in children and analyze the survival and prognostic factors, and long-term outcome. We reviewed 332 OLTs performed in 280 children between the years 1986 and 2000. Univariate and multivariate analysis were performed on patient and graft survivals according to recipients' and donors' characteristics as well as intraoperative data.

Side-effects of postoperative epidural analgesia in children: a randomized study comparing morphine and clonidine.

Background: Morphine is widely used in association with local anaesthetics for postoperative epidural analgesia. There are no data on the prolonged use of clonidine for postoperative analgesia in children. The primary outcome of this randomized, double-blind trial was to compare the incidence of side-effects after epidural infusion of clonidine or morphine, in association with ropivacaine in children.

Epidural analgesia in a child with sickle cell disease complicated by acute abdominal pain and priapism.

We describe a case of a 9-yr-old child with sickle cell disease complicated by abdominal vaso-occlusive crisis and priapism. Both complications were successfully treated with a combination of epidural local anesthetics and morphine.

Acute liver failure in infancy: a 14-year experience of a pediatric liver transplantation center.

Clinical charts of 80 infants younger than 1 year who presented over a 14-year period (1986 to 2000) with acute liver failure (ALF), defined as prolonged prothrombin time greater than 17 seconds and decrease of clotting factor V plasma level below 50% of normal, were reviewed retrospectively. The main causes of ALF were inherited metabolic disorders in 42.5% of cases, including mitochondrial respiratory chain disorders in 17, type I hereditary tyrosinemia in 12, and urea cycle disorders in 2; neonatal hemochromatosis in 16% of cases; and acute viral hepatitis in 15% of cases (hepatitis B in 6, herpes virus type 6 in 4, and herpes simplex virus type 1 in 2).

Diagnosis and anaesthesia management of haemophilia during the neonatal period.

We report here the case of a newborn infant admitted to our hospital for moderate gastro-intestinal bleeding. Despite abnormal value for aPTT, diagnosis of moderate haemophilia A was only made preoperatively when surgery was deemed necessary to treat pyloric stenosis. Clinical circumstances of the diagnosis and anaesthesia management of haemophilia during the neonatal period are discussed.

Reversal of hypoxemia by inhaled nitric oxide in children with severe hepatopulmonary syndrome, type 1, during and after liver transplantation.

Background: The hepatopulmonary syndrome with profound hypoxemia is a rare but severe complication for children with liver cirrhosis. It can be reversed by liver transplantation (LT), which is now regarded as a good indication. However, previous reports have described cases of transient or fatal deteriorations of intrapulmonary shunting after pediatric liver transplantation with dramatically worsening hypoxemia.

Effects of graded hemorrhage on short-term variability of blood pressure in conscious rats.

A controlled graded bleeding was performed in conscious rats with 15 min intervals between two withdrawals, in order to induce a 25% blood loss without hypotension. Heart rate (HR) was unaffected as well. The spectral profiles of systolic blood pressure (SBP) analyzed on 51.