Anesthetic issues in pediatric liver transplantation.

Pediatric liver transplantations are becoming increasingly more common. Recent advances in the surgical and anesthetic management of these cases have greatly improved the survival rate. In order to successfully manage the anesthesia in these patients, one needs to have a thorough understanding of the pathophysiology of end-stage liver disease and the subsequent anesthetic implications. It is also necessary to appreciate the stages of the surgical procedure, as each stage presents different dilemmas to the anesthesiologist. This article will review the pathophysiology of liver failure in pediatric patients and outline the particular issues related to each stage of liver transplantation, allowing for the anticipation and management of the derangements that occur during surgery.