INDICATIONS: The patient is a 17-month-old baby girl with biliary

INDICATIONS: The patient is a 17-month-old baby girl with biliary atresia, who had a delayed diagnosis and a late attempted Kasai portoenterostomy, which failed. The patient has progressive cholestatic jaundice and is on the liver transplant list at University Hospital. The patient is fed by mouth and also with nasogastric enteral feeding supplements. She has had a cough and relatively disinterested in oral intake for the past month. She was recently in the GI Clinic and an x-ray was ordered to check her tube placement and an incidental finding of a coin in the proximal esophagus was noted. Based on the history, it is quite possible this coin has been there close to a month. She is brought to the operating room now for attempted removal. I met with the parents and talked to them at length about the procedure and the increased risk in a child with a coin that has been in for a prolonged period of time. Hopefully, there will be no coin migration or significant irrigation that would require prolonged hospitalization. DESCRIPTION OF OPERATION: The patient came to the operating room and had induction of general anesthesia. She was slow to respond to the usual propofol and other i

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