Anesthesiology Oral Board Flash Cards > Procedures

Hepatic Resection or Transplant

"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: CV—hyperdynamic circulation, increased CI, LVH, PHTNRespiratory—restrictive defect (ascites), pleural effusion, shunting (hepatopulmonary syndrome)Renal—hepatorenal syndrome, ATNMetabolic—hyponatremia, hypomagnesemia, hyperkalemia, metabolic acidosis, hypoglycemiaHematology—reduced synthesis of vitamin K-dependent factors, DIC, anemia, thrombocytopeniaCNS—encephalopathy, cerebral edema

Risk of massive bleeding and hemorrhage

Surgical maneuvers to reduce hepatic inflow (and reduce bleeding): Pringle maneuver—clamp portal vein and hepatic artery—decrease CO and increase afterload. Total hepatic vascular occlusion—clamp supra- and infra-hepatic IVC, portal vein and hepatic artery—hypotension and decrease CO (up to 60%)

Postoperative liver..."