Background: Non-invasive goal directed fluid therapy during deceased donor renal transplant (CRT) may reduce the incidence of delayed graft function. Plethysmograph Variability Index (PVI) has been shown to predict fluid responsiveness during surgery. This pilot study evaluated the feasibility of goal directed fluid administration protocol based upon PVI studying the incidence of delayed graft function (DGF) in renal transplant recipients. Methods: Twenty patients underwent primary CRT. The Control group received intravenous fluid (IVF) at a calculated constant rate. The Treatment group received a baseline IVF infusion throughout the surgery. PVI values greater than 13% were treated with 250 ml boluses of IVF. Primary end point was DGF; total IVF administration and urinary biomarker NGAL levels were secondary endpoints. Results: Treatment group at every time point received significantly less IVF. There was no significant difference in incidence of DGF between the groups. 2 patients in the Control group and 6 in the Treatment group developed DGF. NGAL was not associated with the group assignment or total IVF given (p < 0.2). Conclusions: The effectiveness of goal directed fluid therapy with non-invasive dynamic parameters has not been validated in renal transplant surgery and larger prospective studies are needed to determine its utility in renal transplantation.

Stridor is a high-pitched sound representing partially obstructed or turbulent flow in the airway. Stridor can be part of the inspiratory or expiratory phase, depending on the origin of the flow disturbance. This chapter reviews the etiology of stridor and its subtypes. It also focuses on two important pediatric disease states where stridor is a defining characteristic: epiglottitis and croup. Epiglottitis has emerged as an uncommon cause of pediatric airway compromise, with the widespread use of Haemophilus influenza type b vaccination. Croup continues to be a significant cause of stridor, and is much more common, although less life-threatening. Current opinions on initial evaluation, anesthetic induction, intubation, and follow-up care for both diseases are discussed.

Pyloric stenosis is one of the most common surgical conditions affecting neonates and young infants. Hypertrophy of the pyloric muscular layers results in gradual gastric outlet obstruction. Persistent episodic projectile vomiting and dehydration as well as hypochloremic, hypokalemic metabolic alkalosis are cardinal features. Definitive treatment is surgical pyloromyotomy, but it is not a surgical emergency. Emergency medical intervention is often required to correct intravascular volume depletion and electrolyte disturbances. Morbidity and mortality should be limited due to advancements in surgical and perioperative care. Morbidity can occur due to poor preoperative resuscitation, anesthetic management difficulties, or postoperative complications. The following manuscript is a review of current evidence-based perioperative care of infants with pyloric stenosis. It reviews the pathophysiology that results in metabolic disturbances and intravascular volume depletion. It focuses on preoperative assessment and correction of electrolyte abnormalities and anesthetic technique including airway management and postoperative analgesia.