Pediatric posttransplant anesthesia: a summary review of the literature with recommendations for clinical practice.

Premature pediatric patients who previously received a multivisceral organ transplant and subsequently present for nontransplant surgery will offer multiple challenges to the anesthesia practitioner caring for the patient during the operative period. Multivisceral organ transplant is a treatment option for patients with irreversible intestinal and hepatic failure. Physiologic complications of this population include bronchopulmonary dysplasia, reactive airway disease, and delayed gastric motility. Because of prolonged hospitalization and chronic illness, this population frequently is difficult to achieve peripheral venous access. Immunosuppressive medications may result in lymphoproliferation of the airway, increased risk of infection, alterations in organ system function, and the need to ensure continuation of scheduled immunosuppression therapy. The posttransplant pediatric patient has been exposed to prolonged periods of sedation while in the intensive care unit, resulting in pharmacodynamic tolerance to common anesthetic medications. A review of the current literature in the management of this challenging patient population is presented.