Review articleAnesthetic considerations during liver surgery
Section snippets
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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Cited by (41)
Anesthetic and operative considerations for laparoscopic liver resection
2017, Surgery (United States)Citation Excerpt :Nevertheless, clinical assessment can risk stratify patients into low and high-risk categories for screening with echocardiography or invasive angiography.26 Because of the physiologic stress caused by major vascular exclusion in liver operation and based on the 2014 ACC/AHA (American College of Cardiology/American Heart Association) guidelines for the cardiac evaluation and management of patients undergoing noncardiac operation, some advocate for at least pharmacologic or exercise stress echocardiography for preoperative assessment.27,28 Stress on the cardiovascular system that accompanies surgical techniques used in LLR, including vascular occlusion and pneumoperitoneum, should be considered in the preoperative assessment of the fitness of the cardiovascular system for operation.
Chapter 106 - Vascular isolation techniques in hepatic resection
2017, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas: Sixth EditionContemporary Perioperative Anesthetic Management of Hepatic Resection
2016, Advances in AnesthesiaVascular isolation
2012, Blumgart's Surgery of the Liver, Biliary Tract and PancreasAnaesthesia and the perioperative management of hepatic resection
2011, Trends in Anaesthesia and Critical CareCitation Excerpt :In the postoperative period after large liver resections plain bupivacaine without fentanyl may become necessary. Some authorities argue that the risk from epidural analgesia is too great because of the risk of abnormal coagulation.16 However, the evidence for a high rate of complications is lacking.