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

Year 2013, Volume: 5 , - , 29.06.2013

Sathyanarayan J Praveenkumar Ba Shio Priye Bhaskar Bv Durgaprasad Reddy

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

References

• Stephen P, Fischer, Angela M, Bader, BobbieJean Sweitzer. Preoperative Evaluation. In: Miller RD, Editor. Miller’s anesthesia. 7th ed. Philadelphia: Churchill Livingstone 2010, p1026-1028.
• Jules L Dienstag. Acute Viral Hepatitis. In: T.R.Harrison, Editor. Harrison’s principles of internal medicine. 17th Ed. The McGrawHill Companies, Inc; 2008, p1932-1939. Befeler AS, Palmer DE, Hoffman M, Longo W, Solomon H, Di Bisceglie AM. The safety of intra-abdominal surgery in patients with cirrhosis: Model for End-Stage Liver Disease score is superior to Child-Turcotte-Pugh classification in predicting outcome. Arch Surg 2005; 140:650-654.
• Ziser, Avishai, Plevak et al. Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Anesthesiology 1999; 90:42-53.
• Rothenberg DM, O’Connor CJ, Tuman KJ. Anesthesia and the Hepatobiliary System in: Miller RD, Editor. Miller’s anesthesia. 7th edition. Philadelphia; Churchill Livingstone 2010, p2139-2140.
• Christiansen CL, Ahlburg P, Jakobsen C, Andresen EB, Paulsen PK. The influence of propofol and midazolam/ halothane anesthesia on hepatic and gastric mucosal pH during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1998; 12:418-421.
• Tegeder I, Lötsch J, Geisslinger G. Pharmacokinetics of opioids in liver disease. Clin Pharmacokinet 1999;37:17-40.
• Koizumi M, Matsumoto N, Uede K. Influences of cardiopulmonary bypass and fentanyl anesthesia on hepatic circulation and oxygen metabolism in beagles. Anesth Analg 1998; 96:1177-1187.
• Hampton WW, Townsend MC, Schirmer WJ, Haybron DM, Fry DE. Effective hepatic blood flow during cardiopulmonary bypass. Arch Surg. 1989;124:458-9.
• Mathie RT. Hepatic blood flow during cardiopulmonary bypass. Crit Care Med. 1993;21:S72-6.
• Mathie RT, Ohri SK, Batten JJ, Peters AM, Keogh BE. Hepatic blood flow during cardiopulmonary bypass operations: The effect of temperature and pulsatility. J Thorac Cardiovasc Surg 1997; 114:292-3.