Review article
Anesthetic considerations during liver surgery

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Preoperative considerations

Our experience with hepatectomy over nearly 2 decades has spanned a broad range of clinical scenarios, ranging from the healthy living donor to the patient with advanced cirrhosis undergoing local excision of a malignancy. The preoperative assessment is tailored to accommodate the clinical needs of the patient, estimating the need for invasive monitoring based on the extent of resection and the general health of the patient. Otherwise healthy individuals presenting for even extensive liver

Induction and monitoring

Liver resections are performed under general anesthesia with endotracheal intubation and controlled ventilation. Patients presenting with significant ascites or other risk factors for regurgitation of stomach contents undergo rapid sequence induction to secure the airway; otherwise the anesthetic induction is adapted to the general condition of the patient. Maintenance of anesthesia is achieved using a halogenated volatile agent (most commonly isoflurane, which is a potent peripheral

Postoperative care

Approximately 20% of otherwise healthy patients may experience postoperative complications after elective liver resections [6]. The most frequent of these are pulmonary infection and abdominal abscesses, both usually responsive to antibiotic therapy. Less frequent but more significant complications include postoperative hemorrhage necessitating re-exploration, hepatic, and renal failure. Preoperative American Society of Anesthesiologists (ASA) classification, presence of steatosis, extent of

Summary

This article demonstrates the broad range of considerations that affect the outcome of patients undergoing hepatectomy. The progressive improvements in survival, despite the increasing complexity of the surgery, are a testament to advances in both surgery and anesthesia. The key elements include careful patient selection, appropriate monitoring, and mechanical and pharmacologic protection of the liver and other vital organs.

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