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Continuing Education in Anaesthesia, Critical Care & Pain 2009 9(1):1-5; doi:10.1093/bjaceaccp/mkn050
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© The Board of Management and Trustees of the British Journal of Anaesthesia [2009]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Anaesthesia for hepatic resection surgery

Andrew Hartog, BMedSci BM BS FRCA
Specialist Registrar in Anaesthesia
Royal Hallamshire Hospital
Sheffield
UK

Gary Mills, BMedSci MBChB PhD DICM FRCA
Consultant in Anaesthesia and Critical Care
Royal Hallamshire Hospital
Glossop Road
Sheffield S10 2JF
UK
Tel: +44 (0)114 2712381 Fax: +44 (0)114 2762077 E-mail: gary.mills@sth.nhs.uk

The first 150 words of the full text of this article appear below.


Key points

The liver can regenerate functionally active tissue after resection.
The commonest indication for hepatic resection in the UK is for liver metastases from colorectal cancer, for which it is the treatment of choice.
There is a potential for major perioperative blood loss, which is a risk factor for postoperative liver failure.
Central venous pressure should ideally be <5 cm H2O during resection to minimize bleeding.
Postoperative liver failure has a high mortality.

 

The liver is the only mammalian organ that can regenerate functionally active parenchyma after tissue loss. Exploitation of this physiological property has allowed for the liver resection surgery to develop, and it is now a commonly performed procedure. During the 1970s, perioperative mortality for hepatic resection was quoted around 20%, commonly because of uncontrollable bleeding and postoperative liver failure. Improvements in the understanding of liver anatomy, patient selection, and also surgical and anaesthetic techniques have . . . [Full Text of this Article]


   Indications
 

   Liver anatomy
 

   Regeneration
 

   Surgical technique
 
Initial phase

Resection

Confirmation of haemostasis and abdominal closure


   Preoperative assessment
 

   Assessment of liver function
 

   Perioperative management
 
Monitoring

Conduct of anaesthesia

Analgesia


   Strategies to reduce intra-operative bleeding
 
Low CVP

Aprotinin

Tranexamic acid


   Strategies to reduce the incidence of postoperative liver failure
 
Ischaemia–reperfusion injury


   Postoperative management
 
Normal postoperative course

Postoperative care


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