Anesthetic management of orthotopic liver transplantation (OLT) in pediatric patients is challenging in terms of intraoperative bleeding, fluid management and hemodynamic monitoring. The pulse contour cardiac output (PiCCO) system is a relatively new device based on the single indicator transpulmonary dilution technique. However, its use for introoperative hemodynamic monitoring in pediatric patient has not been reported yet. This is a preliminary report of PiCCO use in five patients undergoing OLT. Five children aged between 3.73±5.46 years (1-17 years) were evaluated. Routine institutional protocol was used for anesthesia induction and maintenance. Intravenous induction with thiopental, fentanyl and vecoronium; followed by maintenance with isofluorane/air/O2 and remifentanil infusion. Hemodynamic volumetric parameters monitored by PiCCO system were mean arterial pressure (MAP), systemic vascular index (SVI), continous cardiac index (CI), intrathoracic blood volume index (ITBVI), extravascular lung water index (EVLWI), stroke volume variability (SVV). All parameters were recorded at four time intervals (after anethesia induction, t1; at the end of unhepatic phase, t2; after reperfusion, t3; at the end of operation, t4). Amount of blood products used intraopertively was 99±11.1 ml/kg, use of crystalloids was 63.5±23.5 ml/kg, use of colloids was 42.3±18.4ml/kg. There were no perioperative hemodynamic or respiratory complications. There were no technical and/or infectious complications either. Postoperative duration of mechanical ventilation was 1.3±0.76 hrs, length of ICU stay was 54.6±31.7 hrs and hospital stay was 20.0±6.6 days.

Time	CI	CVP	MAP	ITBVI	EVLWI	SVI
t1	6.0±1.9	10.8±2.4	70.7±5.2	868±278	10.8±13.2	58.5±20.8
t2	4.7±2.3	7.7±2.2	66.9±18.2	614±225	8.0±2.1	40.0±26.8
t3	6.2±1.1	8.5±3.1	77.5±14.5	623±103	12.8±9.6	53.0±9.1
t4	5.8±2.0	77±2.2	71.7±13.3	675±111	6.6±3.3	50.0±10.0

These findings demonstrated that PiCCO system is a safe, continous and multi-parameter invasive monitoring device in pediatric patients undergoing OLT. It may appear to be a promising monitoring method in other major pediatric surgeries as well.