Anesthesia and Intraoperative Management in Liver Surgery

Abstract

Liver is one of the most complex organs in the body, and it is responsible for a huge range of important metabolic processes, such as coagulation factor synthesis, carbohydrate metabolism, bile acid synthesis, and drug metabolism. The presence of an underlying hepatic disease, such as cirrhosis, is an important determinant of intraoperative and postoperative outcome. Even in the case of benign tumors, the preoperative evaluation and the anesthetic management must consider the possible underlying liver dysfunction. PlanningHepatic resection is considered to be a high-risk surgery, with a perioperative mortality in high-volume centers estimated to 1-7 %, depending on the extent of the resection [ 1 ]. Risk factors associated with elevated mortality and morbidity include the extent and the complexity of the hepatic resection, the associated major biliary procedure, the amount of the intraoperative blood loss, the presence of thrombocytopenia and other comorbid conditions, as well as patient age.Patients without chronic liver dysfunction or cirrhosis scheduled for hepatic resection should be evaluated as any patient scheduled for major noncardiac surgery.