Baris Cankaya
Marmara University Medical Faculty Training Hospital, Turkey
Title: Sedation for pediatric patient with end stage hepatic disease outside operating room
Biography
Biography: Baris Cankaya
Abstract
Sedation outside operating room for children has increasing importance. Paediatric patients with end stage liver disease are of great importance for various and frequent procedures including gastrointestinal endoscopy, magnetic resonance imaging, computerized tomography, brachytherapy, catheterisation, interventional radiology. Anaesthesia plan plays critical role for the success of these procedures. Patient safety, ventilation, hemodynamic responses, side effects of anesthetics on liver, periprocedural analgesia are the main topics of attention. Informed consent, silent environment are needed. Airway management tools may help because of edema and ascites pushing diaphragm upwards resulting in lung atelectasis. Nasal capnography enables monitoring spontaneous ventilation. Enlargement of extravascular extracellular fluid and dysproteinemia effects drug behaviours. Drug elimination half-time as well as context sensitive half-time have to be taken into account and designed individually. The pressure above vena cava inferior results in preload decrease, thus reduction in cardiac output. Pulse wave variation monitoring helps for estimating circulating fluid status. Tendency for bleeding can be anticipated with fresh frozen plasma. Patient-controlled analgesia may be a choice of favour but close monitoring required for repeated iv. analgesics. Children's Hospital of Eastern Ontario Pain Scale would be a good monitoring tool for pain.