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A Case of Difficult Arterial Cannulation: Is Intra-Arterial Blood Pressure Monitoring an Absolute Requirement for Paediatric Liver Transplantation?

Invasive arterial blood pressure monitoring is the standard of practice in terms of intraoperative blood pressure surveillance during liver transplantation. While this is an ideal, achieving reliable arterial access can be extremely challenging in the paediatric and neonatal population, repeated att...

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Autores principales: McKevitt, Helen, Milan, Zoka
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342405/
https://www.ncbi.nlm.nih.gov/pubmed/37445424
http://dx.doi.org/10.3390/jcm12134387
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author McKevitt, Helen
Milan, Zoka
author_facet McKevitt, Helen
Milan, Zoka
author_sort McKevitt, Helen
collection PubMed
description Invasive arterial blood pressure monitoring is the standard of practice in terms of intraoperative blood pressure surveillance during liver transplantation. While this is an ideal, achieving reliable arterial access can be extremely challenging in the paediatric and neonatal population, repeated attempts at arterial cannulation are not without risk and alternative best practice means of haemodynamic monitoring are not clearly established. We describe a case of paediatric liver transplantation in a 3.9 kg infant that was complicated by difficult arterial cannulation, and we suggest that, when reasonable attempts to achieve intra-arterial access have failed, it is safe to proceed with paediatric liver transplantation with non-invasive blood pressure monitoring at 2 min intervals throughout the case and 1 min intervals at reperfusion. We recognise the unique technical challenges in paediatric liver transplant anaesthesia, and we advocate for the establishment of formal clinical training competencies in line with adult practice recommendations. We recommend the use of the Seldinger technique under ultrasound guidance as a first-line approach when difficult arterial cannulation is anticipated, and we discuss techniques for alternative approaches. We suggest that additional alternative means of haemodynamic monitoring should be considered when arterial access cannot be established; however, as no method demonstrates absolute superiority, one or a combination of techniques should be considered, depending on local availability and expertise.
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spelling pubmed-103424052023-07-14 A Case of Difficult Arterial Cannulation: Is Intra-Arterial Blood Pressure Monitoring an Absolute Requirement for Paediatric Liver Transplantation? McKevitt, Helen Milan, Zoka J Clin Med Case Report Invasive arterial blood pressure monitoring is the standard of practice in terms of intraoperative blood pressure surveillance during liver transplantation. While this is an ideal, achieving reliable arterial access can be extremely challenging in the paediatric and neonatal population, repeated attempts at arterial cannulation are not without risk and alternative best practice means of haemodynamic monitoring are not clearly established. We describe a case of paediatric liver transplantation in a 3.9 kg infant that was complicated by difficult arterial cannulation, and we suggest that, when reasonable attempts to achieve intra-arterial access have failed, it is safe to proceed with paediatric liver transplantation with non-invasive blood pressure monitoring at 2 min intervals throughout the case and 1 min intervals at reperfusion. We recognise the unique technical challenges in paediatric liver transplant anaesthesia, and we advocate for the establishment of formal clinical training competencies in line with adult practice recommendations. We recommend the use of the Seldinger technique under ultrasound guidance as a first-line approach when difficult arterial cannulation is anticipated, and we discuss techniques for alternative approaches. We suggest that additional alternative means of haemodynamic monitoring should be considered when arterial access cannot be established; however, as no method demonstrates absolute superiority, one or a combination of techniques should be considered, depending on local availability and expertise. MDPI 2023-06-29 /pmc/articles/PMC10342405/ /pubmed/37445424 http://dx.doi.org/10.3390/jcm12134387 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
McKevitt, Helen
Milan, Zoka
A Case of Difficult Arterial Cannulation: Is Intra-Arterial Blood Pressure Monitoring an Absolute Requirement for Paediatric Liver Transplantation?
title A Case of Difficult Arterial Cannulation: Is Intra-Arterial Blood Pressure Monitoring an Absolute Requirement for Paediatric Liver Transplantation?
title_full A Case of Difficult Arterial Cannulation: Is Intra-Arterial Blood Pressure Monitoring an Absolute Requirement for Paediatric Liver Transplantation?
title_fullStr A Case of Difficult Arterial Cannulation: Is Intra-Arterial Blood Pressure Monitoring an Absolute Requirement for Paediatric Liver Transplantation?
title_full_unstemmed A Case of Difficult Arterial Cannulation: Is Intra-Arterial Blood Pressure Monitoring an Absolute Requirement for Paediatric Liver Transplantation?
title_short A Case of Difficult Arterial Cannulation: Is Intra-Arterial Blood Pressure Monitoring an Absolute Requirement for Paediatric Liver Transplantation?
title_sort case of difficult arterial cannulation: is intra-arterial blood pressure monitoring an absolute requirement for paediatric liver transplantation?
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342405/
https://www.ncbi.nlm.nih.gov/pubmed/37445424
http://dx.doi.org/10.3390/jcm12134387
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