Biliary Atresia, Hepatic Buffer Response and Sevoflurane

Children suffering from hepatobiliary disease also have an hepatic arterial buffer response (HABR) with reduced portal vein blood flow (PBF) and compensatory increases in hepatic arterial blood flow (HABF) which can help maintain hepatic blood flow (HBF). For infants with obstructive hepatobiliary disease, reduced HBF may affect drug metabolism and increase the risk of respiratory depression during analgesia, which can be life-threatening.

To evaluate the effects of sevoflurane on HBF and HABR in infants with obstructive jaundice by Doppler ultrasound.Twenty-five infants with biliary atresia (1-3 months-of-age) scheduled for a Kasai procedure were enrolled. PBF, HABF and HBF were measured by Doppler ultrasound before induction, and after inhalation of 2 and 3% sevoflurane.

Inclusion criteria

• persistent yellow skin or sclera, pale stool (in severe cases, clay-like), and hepatomegaly;
• increased serum bilirubin (progressively or no decline after increase), increased total bilirubin (TBil) dominated by increased direct bilirubin (DBil) (>60%);
• elevated liver enzymes;
• ultrasound confirmation of poor gallbladder filling and signs of liver fibrosis;
• with radionuclide imaging confirmation of obstructed biliary excretion

Exclusion criteria

• concomitant cardiovascular or abdominal organ malformations