Anaesthesia for Liver Transplantation: An Update

Liver transplantation (LT) is a challenging surgery performed on patients with complex physiology profiles, complicated by multi-system dysfunction. It represents the treatment of choice for end-stage liver disease. The procedure is performed under general anaesthesia, and a successful procedure req...

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Main Authors: Brezeanu Lavinia Nicoleta, Brezeanu Radu Constantin, Diculescu Mircea, Droc Gabriela
Format: Article
Language:English
Published: Sciendo 2020-05-01
Series:The Journal of Critical Care Medicine
Subjects:
Online Access:https://doi.org/10.2478/jccm-2020-0011
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spelling doaj-d021df140c4644f199e520f8575d951f2021-09-06T19:41:34ZengSciendoThe Journal of Critical Care Medicine2393-18172020-05-01629110010.2478/jccm-2020-0011jccm-2020-0011Anaesthesia for Liver Transplantation: An UpdateBrezeanu Lavinia Nicoleta0Brezeanu Radu Constantin1Diculescu Mircea2Droc Gabriela3Fundeni Clinical Institute, Bucharest, Romania“Bagdasar-Arseni” Emergency Hospital, Bucharest, RomaniaFundeni Clinical Institute, Bucharest, RomaniaFundeni Clinical Institute, Bucharest, RomaniaLiver transplantation (LT) is a challenging surgery performed on patients with complex physiology profiles, complicated by multi-system dysfunction. It represents the treatment of choice for end-stage liver disease. The procedure is performed under general anaesthesia, and a successful procedure requires an excellent understanding of the patho-physiology of liver failure and its implications. Despite advances in knowledge and technical skills and innovations in immunosuppression, the anaesthetic management for LT can be complicated and represent a real challenge. Monitoring devices offer crucial information for the successful management of patients. Hemodynamic instability is typical during surgery, requiring sophisticated invasive monitoring. Arterial pulse contour analysis and thermo-dilution techniques (PiCCO), rotational thromboelastometry (RO-TEM), transcranial doppler (TCD), trans-oesophageal echocardiography (TEE) and bispectral index (BIS) have been proven to be reliable monitoring techniques playing a significant role in decision making. Anaesthetic management is specific according to the three critical phases of surgery: pre-anhepatic, anhepatic and neo-hepatic phase. Surgical techniques such as total or partial clamping of the inferior vena cava (IVC), use of venovenous bypass (VVBP) or portocaval shunts have a significant impact on cardiovascular stability. Post reperfusion syndrome (PRS) is a significant event and can lead to arrhythmias and even cardiac arrest.https://doi.org/10.2478/jccm-2020-0011liver transplantationhaemodynamic monitoringpost-reperfusion syndrome
collection DOAJ
language English
format Article
sources DOAJ
author Brezeanu Lavinia Nicoleta
Brezeanu Radu Constantin
Diculescu Mircea
Droc Gabriela
spellingShingle Brezeanu Lavinia Nicoleta
Brezeanu Radu Constantin
Diculescu Mircea
Droc Gabriela
Anaesthesia for Liver Transplantation: An Update
The Journal of Critical Care Medicine
liver transplantation
haemodynamic monitoring
post-reperfusion syndrome
author_facet Brezeanu Lavinia Nicoleta
Brezeanu Radu Constantin
Diculescu Mircea
Droc Gabriela
author_sort Brezeanu Lavinia Nicoleta
title Anaesthesia for Liver Transplantation: An Update
title_short Anaesthesia for Liver Transplantation: An Update
title_full Anaesthesia for Liver Transplantation: An Update
title_fullStr Anaesthesia for Liver Transplantation: An Update
title_full_unstemmed Anaesthesia for Liver Transplantation: An Update
title_sort anaesthesia for liver transplantation: an update
publisher Sciendo
series The Journal of Critical Care Medicine
issn 2393-1817
publishDate 2020-05-01
description Liver transplantation (LT) is a challenging surgery performed on patients with complex physiology profiles, complicated by multi-system dysfunction. It represents the treatment of choice for end-stage liver disease. The procedure is performed under general anaesthesia, and a successful procedure requires an excellent understanding of the patho-physiology of liver failure and its implications. Despite advances in knowledge and technical skills and innovations in immunosuppression, the anaesthetic management for LT can be complicated and represent a real challenge. Monitoring devices offer crucial information for the successful management of patients. Hemodynamic instability is typical during surgery, requiring sophisticated invasive monitoring. Arterial pulse contour analysis and thermo-dilution techniques (PiCCO), rotational thromboelastometry (RO-TEM), transcranial doppler (TCD), trans-oesophageal echocardiography (TEE) and bispectral index (BIS) have been proven to be reliable monitoring techniques playing a significant role in decision making. Anaesthetic management is specific according to the three critical phases of surgery: pre-anhepatic, anhepatic and neo-hepatic phase. Surgical techniques such as total or partial clamping of the inferior vena cava (IVC), use of venovenous bypass (VVBP) or portocaval shunts have a significant impact on cardiovascular stability. Post reperfusion syndrome (PRS) is a significant event and can lead to arrhythmias and even cardiac arrest.
topic liver transplantation
haemodynamic monitoring
post-reperfusion syndrome
url https://doi.org/10.2478/jccm-2020-0011
work_keys_str_mv AT brezeanulavinianicoleta anaesthesiaforlivertransplantationanupdate
AT brezeanuraduconstantin anaesthesiaforlivertransplantationanupdate
AT diculescumircea anaesthesiaforlivertransplantationanupdate
AT drocgabriela anaesthesiaforlivertransplantationanupdate
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