Longnecker's Anesthesiology > Part 4. Managing Anesthesia Care > Section E. Specialty Areas of Anesthetic Practice > Chapter 56. Anesthesia for Liver Surgery and Transplantation Warren S. Sandberg, MD, PhD, and Douglas E. Raines, MD

Key Points

"1. Patients with chronic liver dysfunction and cirrhosis have a hyperdynamic circulation with low peripheral vascular resistance and an increased cardiac index.

2. Coagulopathies, edema and ascites, renal dysfunction, portopulmonary hypertension, hepatopulmonary syndrome, and autonomic neuropathies are common in patients with liver disease.

3. The cause of hepatic encephalopathy is believed to be multifactorial. Hepatic encephalopathy resembles, and must be differentiated from, many other nonfocal neurologic conditions, such as hypoglycemia, hyponatremia, intracranial hemorrhage or mass lesions, and meningitis.

4. Patients scheduled for hepatic resection should be evaluated as any patient scheduled for major noncardiac surgery. Plans for monitoring, vascular access, induction and maintenance of anesthesia, postoperative pain control, and postoperative care should take into account a large subcostal incision and the potential for sudden massive hemorrhage and severe physiologic derangements during and after surgery.

5. The most common indication for liver transplantation is chronic hepatocellular disease because of alcohol and/or hepatitis. Hepatitis C is increasingly important, representing a unique and growing health risk for anesthesiologists.

6. Cardiac assessment of the patient being considered for liver transplantation focuses on functional..."