ANESTHESIA FOR KASAI PROCEDURE AT INFANT 40 DAYS OLD WITH

BILIARY ATRESIA WITH COMPLETTE ATRIOVENTRICULAR SEPTAL

DEFECT (CAVSD)
Nof Eva Sari Tarigan, Sofyan Harahap

Anesthesiology and Intensive Care Medical Faculty of Diponegoro University/Dr Kariadi Hospital,
Semarang

ABSTRACT
Introduction
Biliary atresia is a congenital condition which there is a blockage in the tubes that carry bile
from the liver to the gallbladder that occurs when the bile ducts inside or outside the liver do
not develop. Complette Atrioventricular Septal Defect (CAVSD) is a birth defect of the heart
in which there are holes between chambers of the heart, and the valves that control the flow
of blood between these chambers may not be formed correctly. This occurs when there is a
large opening in the center of the heart where the wall from the top of the heart (atrial
septum) and the wall from the bottom of the heart (ventricular septum) would normally meet.
There is a hole in both the atrial septum and the ventricular septum. Also, instead of blood
flowing from the atria to the ventricles through atricuspid valve on the right side of the heart
and a mitral valve on the left side of the heart, there is one common valve in the middle of the
heart.
Objective
To report the anesthetic management of Kasai prosedure in infant with biliary atresia with
Complette Atrioventricular Septal Defect ( CAVSD)
Method
A 40 days old infant weighs 4,000 grams with billiary athresia who undergo Kasai procedure
with Complette Atrioventricular Septal Defect (CAVSD) with physical status ASA III, the
problems of preoperative are hypoalbuminemia (2.4 g / dL), hepatic enzyme elevations
( SGOT: 763; SGPT: 457); dekstrokardi with ambiguous sites; pulmonary stenosis with PG:
40mmHg; hidroneprose moderate renal dekstra. Before surgery, the patients was hospitalized
at Pediatric High Care Unit on head box with SpO2; 64-72% and jaundice and cyanotic.
GA intubation techniques was installed of Central Venous Pressure (CVP) line.

Premedication was given sulfa atropine 0.01 mg / kg. Induction using ketamine 2mg / kg and
rocuronium 1 mg / kg. After intubation heart rate 150 beat / min, SpO2 75-85%. Anesthesia
maintenance technique with oxygen and air, controlled by ventilator and ketamine 1 mg / kg /
hour. Rocuronium was given 1 mg / kg intermittent. After two hours heart rate 60-70 beat /
min, SpO2 50-60%. Sulfa atropine 0,01mg / kg was administration two times and dopamine
5-10 mg / kg, heart rate 140 beats / min, SpO2 75-80%. The third hour operation heart rate
becomes 80-90 beat / min, SpO2 40-50%, administration adrenaline 0,01mg / kg / hour heart
rate becomes 130-150 beats / min, SpO2 70-80%. The surgery last for 5 hours, given RL 150
ml and 40 ml PRC. Post-surgery patients treated at the Pediatric Intensive Care Unit (PICU)
Discussion
General anesthesia in infant with biliary atresia with CAVSD done by minimizing myocardial
depression and maintain or slightly increase PVR and prevent an increase in SVR.
Normokarbi conditions must be maintained after intubation and administration of oxygen
adjusted to keep the pulmonary blood flow equals the systemic blood flow, since the greater
the defect ventricle and mitral valve insufficiency owned will worsen the condition. Inotropic
strut is needed to help the work of the heart.
Conclusion
CAVSD in infant biliary atresia operation by Kasai procedure perform general anesthesia
used ketamin to minimize myocardial depression and maintain or slightly increase PVR and
prevent an increase in SVR.
References
1. Andropoulus DB, Hemodynamic management. Anesthesia for congenital heart
disease. 2nd ed. UK. Willey-Blackwell:2010;287-307
2. Schwartz AJ, Campbell FW. Pathophysiological approach to congenital heart disease.
Pediatric cardiac anesthesia. Norwalk, CT: Apletton & Lange , 2008:9