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Chapter-34 Anesthesia in Liver Transplantation

BOOK TITLE: Liver Transplantation

Author
1. K Dilip Chakravarty
2. Lee WC
3. Jan YY
4. Lee Po-Huang
ISBN
9788184487701
DOI
10.5005/jp/books/10445_34
Edition
1/e
Publishing Year
2010
Pages
9
Author Affiliations
1. Chang Gung Memorial Hospital (Linkou), Taipei, Taiwan (ROC)
2. Chang Gung Transplantation Institute (Linkou), Chang Gung University, Taipei, Taiwan (ROC)
3. Chang Gung Memorial Hospital (Linkou), Chang Gung University, Taipei, Taiwan (ROC)
4. National Taiwan University Hospital, Taipei, Taiwan (ROC)
Chapter keywords

Abstract

Liver transplantation has become the treatment of choice for end stage chronic liver disease and some cases of acute hepatic failure, provided patients are selected without limiting comorbidity. Preoperative assessment is by hepatologist, surgeon and anesthetist prior to listing for transplantation. Assessment is aimed at evaluating both hepatic dysfunction and presence of complications of ESLD and comorbid conditions. Patients often have poor exercise tolerance, ascites and pleural effusions and stigmata of chronic liver disease suggest poor hepatic synthetic function. Presence of portal hypertension and presence of large venous collaterals is a relative contraindication for putting a spinal/epidural catheter due to increased risk of bleeding and hematoma formation. Peripheral nerve block may be selectively. Most transplant recipients require 6–12 hours ventilatory support, in liver transplant ICU. Few patients are suitable for early extubation. Postoperatively sedation is continued usually with propofol and alfentanil infusions. Muscle relaxants are not usually required. K+ supplementation is required for 24–36 hours. Coagulation tests and full blood count guide further transfusion of blood and blood products. Hematocrit is maintained between 0.26 and 0.32. Higher levels are associated with an increased incidence of hepatic artery thrombosis and graft failure.

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