Patients

This study was conducted in agreement with the regulations of the Ethics Committee of the University of Regensburg (approval no. 16-101-0005) and according to the ethics guidelines of the 1975 Declaration of Helsinki. Infants and children who underwent liver transplantation for acute or chronic liver failure at our clinic between March 2011 and March 2016 were included. Patients received no oral premedication and were fasted according to the local protocol. The initial monitoring included electrocardiogram, non-invasive blood pressure, and pulsoxymetric saturation (SpO₂). Anesthesia was induced with sufentanil (0.2 μg/kg per BW), propofol (2–4 mg/kg per BW), and rocuronium (0.5 mg/kg per BW). After intubation, desflurane 0.6–0.9 MAC (in 30–50% O₂/air mixed to keep the paO₂ >100 mmHg) was used for maintaining anesthesia. Gas monitoring for desflurane was performed and end-tidal CO₂, inspiratory and expiratory oxygen concentration, as well as spirometry (gas flows, volumes, and pressures), were measured. Body temperature was measured in the oesophagus and in the bladder via a urinary catheter. In all children, invasive arterial blood pressure, continuous central venous pressure, and urinary output were monitored. Blood for arterial blood gases were taken after the induction of anesthesia, prior to reperfusion, approximately 5 min after reperfusion of the new graft and whenever indicated by the anesthesiologist. The concentrations of hemoglobin, electrolyte, lactate, and glucose and arterial blood gases were measured and recorded. Blood samples to determine laboratory values (for creatinine, cystatin C, and bilirubin) were taken prior to transplantation, on arrival in the ICU, and on the following 7 days in the morning. For volume replacement, the children received crystalloid (5–15 mg/kg/h) and colloidal solutions. Blood transfusion for maintaining the hemoglobin concentration above 7 mg/dl and fresh frozen plasma were transfused when thromboplastin time was below 50% and pooled thrombocyte concentrate in the case of a thrombocyte count below 60 000/μl.