Education  |   April 2018
Intraoperative Phototherapy for Hyperbilirubinemia
Author Notes
  • From the Division of Cardiothoracic Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas.
  • Charles D. Collard, M.D., served as Handling Editor for this article.
    Charles D. Collard, M.D., served as Handling Editor for this article.×
  • Address correspondence to Dr. Adler: adamcadler@gmail.com
Article Information
Education / Images in Anesthesiology / Coagulation and Transfusion / Critical Care / Endocrine and Metabolic Systems / Gastrointestinal and Hepatic Systems / Pediatric Anesthesia / Renal and Urinary Systems / Electrolyte Balance
Education   |   April 2018
Intraoperative Phototherapy for Hyperbilirubinemia
Anesthesiology 4 2018, Vol.128, 811. doi:10.1097/ALN.0000000000001925
Anesthesiology 4 2018, Vol.128, 811. doi:10.1097/ALN.0000000000001925
HYPERBILIRUBINEMIA or jaundice when severe and if untreated has disastrous yet preventable neurotoxic effects, specifically, bilirubin-induced encephalopathy or kernicterus.1,2  Intraoperative phototherapy using an underbody bili blanket (red arrows) can minimize treatment interruptions, which is preferential during light therapy. Although dual-source (anterior and posterior) light therapy is preferred, this may not allow for operative access to the patient. As seen in these images, the patient should be positioned to provide maximal light to skin interface, with the cautery pad positioned to allow maximal light exposure. Patients should be well hydrated and have eye shields because phototherapy may result in dehydration from insensible losses and toxicity to the immature retina. Although surgery should be delayed until hyperbilirubinemia is resolved, in emergent or semiurgent cases, maintenance of phototherapy intraoperatively, especially in lengthy cases, should be considered.
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