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.
References (28)
- et al.
Pulmonary dysfunction in chronic liver disease
Hepatology
(2000) - et al.
Diagnostic utility of contrast echocardiography and lung perfusion scan in patients with hepatopulmonary syndrome
Gastroenterology
(1995) - et al.
Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection
J Am Coll Surg
(2000) - et al.
Impact of the extent of hepatectomy on donor outcomes: liver function and clinical recovery after living donor liver transplantation
Am J Transplant
(2002) - et al.
Preoperative predictors of blood transfusion in liver resection for tumors
Am J Surg
(1997) - et al.
Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction
J Am Coll Surg
(1998) - et al.
Haemodynamic changes associated with portal triad clamping are suppressed by prior hepatic pedicle infiltration with lidocaine in humans
Br J Anaesth
(1999) - et al.
Intraoperative hemodynamics and liver function in adult-to-adult living liver donors
Liver Transpl
(2002) - et al.
Extended hepatic resection: A 6-year retrospective study of risk factors for perioperative mortality
J Am Coll Surg
(2001) - et al.
Surgical and anesthetic management of patients undergoing major hepatectomy with total vascular isolation
Liver Transpl Surg
(1996)