Book chapter
CHAPTER 106 - Liver transplantation: Perioperative anesthetic considerations
Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 2-Volume Set, pp.1554-1568.e6
Elsevier Inc, Seventh Edition
2023
DOI: 10.1016/B978-0-323-69784-2.00131-6
Abstract
This chapter reviews up-to-date evidence for the role of the anesthesiologist as a member of a multidisciplinary team in perioperative care of the liver transplant patient, including patient selection and pretransplant optimization, intraoperative and postoperative management, and participation in quality improvement (QI) programs. In response to increasing societal demands for liver transplantation and consequent donor shortage, dramatic changes in donor organ quality and recipient selection have recently taken place, resulting in older patients, with higher Model for End-Stage Liver Disease (MELD) scores and prevalence of comorbidities, presenting for transplant. Despite the mounting challenges for perioperative physicians, the outcomes have been steadily improving because of advancement and standardization of surgical and anesthetic techniques and the adoption of a systematic approach to QI and patient safety in this demanding multidisciplinary field. Because liver disease affects all organ systems, anesthetic care of orthotopic liver transplantation (OLT) recipients requires a thorough understanding of the pathophysiology of end-stage liver disease (ESLD), including central nervous system (CNS), hematologic, cardiovascular, pulmonary, and renal systems reviewed in the chapter. Understanding anesthetic management and monitoring techniques, including advanced hemodynamic monitoring, CNS monitoring, and point-of-care coagulation testing, is essential for intraoperative management. Insight is provided into common challenges, such as reperfusion syndrome and hypotension, and special situations, such as thromboembolic complications. Common postoperative complications that can potentially be anticipated or may require early return to the operating room are highlighted. We hope that readers will find the chapter a useful review of current anesthetic strategies supporting efficient and high-quality care towards enhancing patient outcomes in liver transplantation.
Details
- Title: Subtitle
- CHAPTER 106 - Liver transplantation: Perioperative anesthetic considerations
- Creators
- Andrea VannucciIvan Kangrga
- Resource Type
- Book chapter
- Publication Details
- Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 2-Volume Set, pp.1554-1568.e6
- Edition
- Seventh Edition
- Publisher
- Elsevier Inc; Philadelphia, PA
- DOI
- 10.1016/B978-0-323-69784-2.00131-6
- Language
- English
- Date published
- 2023
- Academic Unit
- Anesthesia
- Record Identifier
- 9984657731202771
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