Anaesthetic management of ventricular septal defect closure under cardiopulmonary bypass in a child with recently diagnosed hepatitis A.

Abstract

Hepatitis A is highly contagious and is spread largely by the fecal-oral route, more commonly in areas of overcrowding and poor sanitation. Infection is common in children but often asymptomatic. Acute liver failure complicates acute hepatitis A in only 0.1% of cases and chronic infection does not occur. A 2-yr-old female baby was operated for Ventricular Septal Defect (VSD) closure under cardiopulmonary bypass. She was diagnosed to have acute hepatitis A while preoperative evaluation and was decided to operate once the acute phase resolves as indicated by liver enzymes touching baseline. General anesthesia was induced with morphine, atracurium and maintained with morphine, propofol and atracurium. No complications were encountered during perioperative period. We concluded that following acute hepatitis, surgery can be done on cardiopulmonary bypass as early as the acute phase resolves using anesthetic agents that are least hepatotoxic and metabolism of which is less affected by liver disease. Additionally insult from cardiopulmonary bypass can be minimized by reducing bypass time, non pulsatile flows and normothermia. By close follow-up of patients clinically and biochemically, it is possible to reduce the complication rates to a minimum. Key words: Hepatitis A, general anaesthesia, cardiopulmonary bypass, ventricular septal defect.

Keywords

• pediatrics; Hepatitis A; VSD; Anesthesia

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