Anesthetic Management in Pediatric Limb Replantation After Traumatic Amputation

For children who undergo major limb replantation, there is limited guidance for intraoperative anticoagulation protocols or vasopressor use to protect graft patency. We report a case of a 2-year-old female who underwent successful arm replantation after traumatic amputation with a course complicated by hemorrhage and hemodynamic instability. To protect vessel graft patency, we anticoagulated the patient and limited vasopressor use, both of which made resuscitation difficult. Despite these challenges, the replanted limb remained viable. Although guidelines are needed, this case highlights our experience and recommendations for using anticoagulation and vasopressors during major limb replantation in the pediatric population.