A 3-week-old full term male presents with jaundice and is diagnosed with biliary atresia. He has no other evidence of hepatic dysfunction and is scheduled for the Kasai procedure. Preoperatively, which of the following is most appropriate for preparation for this patient?
a) Arterial access
b) Central venous catheter
c) Total Intravenous Anesthesia (TIVA)
d) Warming device
e) All of the above
Answer d. Warming device. In an otherwise healthy infant undergoing primary Kasai procedure (hepatoportoenterostomy), there is usually little concern for blood loss or hemodynamic instability, thus arterial and central venous access are usually not indicated. Gelman et al. showed that isoflurane anesthesia provided better hepatic blood flow and oxygen supply than halothane. TIVA has not been demonstrated to be a superior method of anesthesia. Any neonate undergoing extensive surgery should have all attempts made to prevent hypothermia. 3