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Anesthesiology Oral Board Flash Cards
Hepatic Resection or Transplant
hepatic resection; liver transplantation.
Considerations, History, Physical Exam, Lab Tests/Imaging, Consults, Conflict(s), Optimize, Options, Preop:, Room Setup (Special Drugs/Monitors), Induction, Maintenance, Emergence, Disposition/Pain, Clinical Pearls, References
Hyperkalemia can cause fatal ventricular fibrillation. It requires aggressive treatment (see "Hyperkalemia") and close monitoring (ECG), particularly immediately after reperfusion of transplanted liver. If hyperkalemia is an issue but ongoing blood loss requires blood transfusion, the potassium load can be minimized by having the PRBCs washed.
Orthotopic liver transplant (OLT) for acute or chronic hepatic failure (often hepatitis B or C or alcoholic cirrhosis)
Liver resection for hepatic metastases, cholestatic diseases, or donation for hepatic transplantation
Liver failure is a multi-system disease: CVhyperdynamic circulation, increased CI, LVH, PHTNRespiratoryrestrictive defect (ascites), pleural effusion, shunting (hepatopulmonary syndrome)Renalhepatorenal syndrome, ATNMetabolichyponatremia, hypomagnesemia, hyperkalemia, metabolic acidosis, hypoglycemiaHematologyreduced synthesis of vitamin K-dependent factors, DIC, anemia, thrombocytopeniaCNSencephalopathy, cerebral edema
Risk of massive bleeding and hemorrhage
Surgical maneuvers to reduce hepatic inflow (and reduce bleeding):
clamp portal vein and hepatic arterydecrease CO and increase afterload.
Total hepatic vascular occlusion
clamp supra- and infra-hepatic IVC, portal vein and hepatic arteryhypotension and decrease CO (up to 60%)
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