Anesthesia and Pain Control in Liver Surgery

Author(s): Ney Fuhrmann Leal, Maurício de Oliveira, Vinícius Grando Gava and Silvio Marcio Pegoraro Balzan

Pp: 106-120 (15)

* (Excluding Mailing and Handling)

Abstract

• Anesthetic management plays a key role in the reduction of perioperative causes of mortality in liver surgery, such as bleeding and liver failure.

• Intraoperative reduction of the hepatic blood flow can result from changes in blood volume status and also from mechanical or pharmacological effects, and can lead to liver dysfunction.

• Central venous pressure lower than 5mmHg reduces blood loss during hepatic parenchymal transection.

• Inhalational anesthetics such as sevoflurane, desflurane, and isoflurane can maintainor even increase total hepatic blood flow; meanwhile, intravenous anesthetics have a modest impact on that.

• Intraoperative fluid management should not be guided exclusively by central venous pressure, and the use of colloids (such as 5% albumin) as a maintenance and replacement solution reduces extravascular translocation of fluids.

• Pharmacological preconditioning, mainly with the use of inhaled anesthetics, has been used to prevent ischemia-reperfusion syndrome, although its pathophysiology is not entirely understood.

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