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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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 |
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