Anesthesia for Surgical Procedures in Cirrhotic Patients Other than Liver Transplantation: Management, Concerns, and Pitfalls

Chapter

Abstract

In patients with cirrhosis, the perioperative risk of anesthesia is invariably linked to the severity of hepatic dysfunction and the nature of the procedure, rather than the selection of anesthetic. The MELD (Model for End-stage Liver Disease) score has predictive value for perioperative risk, with MELD scores of 25 or more associated with 1-month mortality of 50%. Surgical procedures near the liver are associated with reductions in hepatic blood flow, which can lead to decompensation and hepatic failure. Other conditions associated with decompensation include preoperative infection, higher ASA (American Society of Anesthesiologists) physical status score, and surgery on the respiratory system. Preoperative medical management should focus on treating infection, optimizing blood volume and renal status, and minimizing ascites and encephalopathy. However, specific goal-directed targets have not been shown to improve outcomes. Routine administration of prophylactic plasma in an attempt to correct INR abnormalities should be avoided, as volume loading is associated with increases in portal pressure that may worsen bleeding. Unique conditions associated with cirrhosis – hepatopulmonary syndrome, portopulmonary hypertension, and hepatorenal syndrome – also increase perioperative risk. Patients with an advanced disease benefit from liver transplantation prior to elective surgery. When such patients require emergency surgery they should be evaluated for minimally invasive and less extensive surgical alternatives. The effects of hepatic dysfunction on perioperative sedation and anesthetic selection are described, as is the anesthetic management of hepatic resection.

Keywords

Anesthesia Anesthetic management Sedation Volatile anesthetic Neuromuscular blocking agent Cirrhosis Perioperative outcomes 

References

  1. 1.
    Prevention CD and C. Hepatitis statistics: surveillance for viral hepatitis – United States. 2013. http://www.cdc.gov/hepatitis/statistics/2013surveillance/commentary.htm.
  2. 2.
    Prevention CD and C. Death rates by age and age-adjusted death rates for the 15 leading causes of death in 2013: United States. 1999–2013. http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf.
  3. 3.
    Csikesz NG, Nguyen LN, Tseng JF, Shah SA. Nationwide volume and mortality after elective surgery in cirrhotic patients. J Am Coll Surg. 2009;208(1):96–103. doi: 10.1016/j.jamcollsurg.2008.09.006.CrossRefPubMedGoogle Scholar
  4. 4.
    Ziser A, Plevak DJ, Wiesner RH, Rakela J, Offord KP, Brown DL. Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Anesthesiology. 1999;90(1):42–53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9915311 CrossRefPubMedGoogle Scholar
  5. 5.
    Powell-Jackson P, Greenway B, Williams R. Adverse effects of exploratory laparotomy in patients with unsuspected liver disease. Br J Surg. 1982;69(8):449–51. http://www.ncbi.nlm.nih.gov/pubmed/7104630 CrossRefPubMedGoogle Scholar
  6. 6.
    Rizvon MK, Chou CL. Surgery in the patient with liver disease. Med Clin North Am. 2003;87(1):211 - +. doi: 10.1016/s0025-7125(02)00153-0.CrossRefPubMedGoogle Scholar
  7. 7.
    Friedman LS, Xu J, Murphy SL, Kochanek KD, Bastian BA, Statistics V. Surgery in the patient with liver disease. Trans Am Clin Climatol Assoc. 2010;121(2):192–204. discussion 205. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20697561 PubMedPubMedCentralGoogle Scholar
  8. 8.
    Aranha GV, Sontag SJ, Greenlee HB. Cholecystectomy in cirrhotic patients: a formidable operation. Am J Surg. 1982;143(1):55–60. http://www.ncbi.nlm.nih.gov/pubmed/7053656 CrossRefPubMedGoogle Scholar
  9. 9.
    Doberneck RC, Sterling Jr WA, Allison DC. Morbidity and mortality after operation in nonbleeding cirrhotic patients. Am J Surg. 1983;146(3):306–9. http://www.ncbi.nlm.nih.gov/pubmed/6604465 CrossRefPubMedGoogle Scholar
  10. 10.
    Garrison RN, Cryer HM, Howard DA, Polk Jr HC. Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Ann Surg. 1984;199(6):648–55. http://www.ncbi.nlm.nih.gov/pubmed/6732310 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Mansour A, Watson W, Shayani V, Pickleman J. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery. 1997;122(4):730–6. http://www.ncbi.nlm.nih.gov/pubmed/9347849 CrossRefPubMedGoogle Scholar
  12. 12.
    Neeff H, Mariaskin D, Spangenberg H-C, Hopt UT, Makowiec F. Perioperative mortality after non-hepatic general surgery in patients with liver cirrhosis: an analysis of 138 operations in the 2000s using child and MELD scores. J Gastrointest Surg. 2011;15(1):1–11. doi: 10.1007/s11605-010-1366-9.CrossRefPubMedGoogle Scholar
  13. 13.
    Freeman RB, Wiesner RH, Harper A, et al. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl. 2002;8(9):851–8. doi: 10.1053/jlts.2002.35927.CrossRefPubMedGoogle Scholar
  14. 14.
    Northup PG, Wanamaker RC, Lee VD, Adams RB, Berg CL. Model for End-Stage Liver Disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis. Ann Surg. 2005;242(2):244–51. 00000658-200508000-00013 [pii]CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Teh SH, Nagorney DM, Stevens SR, et al. Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology. 2007;132(4):1261–9. doi: 10.1053/j.gastro.2007.01.040.CrossRefPubMedGoogle Scholar
  16. 16.
    Raval Z, Harinstein ME, Skaro AI, et al. Cardiovascular risk assessment of the liver transplant candidate. J Am Coll Cardiol. 2011;58(3):223–31. doi: 10.1016/j.jacc.2011.03.026.CrossRefPubMedGoogle Scholar
  17. 17.
    Fede G, Privitera G, Tomaselli T, Spadaro L, Purrello F. Cardiovascular dysfunction in patients with liver cirrhosis. Ann Gastroenterol. 2015;28(1):31–40. http://www.ncbi.nlm.nih.gov/pubmed/25608575 PubMedPubMedCentralGoogle Scholar
  18. 18.
    Zimmon DS, Kessler RE. The portal pressure-blood volume relationship in cirrhosis. Gut. 1974;15(2):99–101. http://www.ncbi.nlm.nih.gov/pubmed/4820643 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Nadim MK, Durand F, Kellum JA, et al. Management of the critically ill patient with cirrhosis: a multidisciplinary perspective. J Hepatol. 2016;64(3):717–35. doi: 10.1016/j.jhep.2015.10.019.CrossRefPubMedGoogle Scholar
  20. 20.
    Jia Q, Brown MJ, Clifford L, et al. Prophylactic plasma transfusion for surgical patients with abnormal preoperative coagulation tests: a single-institution propensity-adjusted cohort study. Lancet Haematol. 2016;3(3):e139–48. doi: 10.1016/s2352-3026(15)00283-5.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Northup PG, McMahon MM, Ruhl AP, et al. Coagulopathy does not fully protect hospitalized cirrhosis patients from peripheral venous thromboembolism. Am J Gastroenterol. 2006;101(7):1524–28; quiz 1680. doi:AJG588 [pii]10.1111/j.1572-0241.2006.00588.x.Google Scholar
  22. 22.
    Tripodi A, Primignani M, Chantarangkul V, et al. An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis. Gastroenterology. 2009;137(6):2105–11. doi: 10.1053/j.gastro.2009.08.045.CrossRefPubMedGoogle Scholar
  23. 23.
    Lisman T, Bakhtiari K, Pereboom IT, Hendriks HG, Meijers JC, Porte RJ. Normal to increased thrombin generation in patients undergoing liver transplantation despite prolonged conventional coagulation tests. J Hepatol. 2010;52(3):355–61. doi: 10.1016/j.jhep.2009.12.001.CrossRefPubMedGoogle Scholar
  24. 24.
    Viegas O, Stoelting RK. LDH5 changes after cholecystectomy or hysterectomy in patients receiving halothane, enflurane, or fentanyl. Anesthesiology. 1979;51(6):556–8. doi: 10.1097/00000542-197912000-00017.CrossRefPubMedGoogle Scholar
  25. 25.
    Shaikh AR, Muneer A. Laparoscopic cholecystectomy in cirrhotic patients. JSLS. 2009;13(4):592–6. doi: 10.4293/108680809X12589999537959.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Curro G, Iapichino G, Melita G, Lorenzini C, Cucinotta E. Laparoscopic cholecystectomy in Child-Pugh class C cirrhotic patients. JSLS. 2005;9(3):311–5. http://www.ncbi.nlm.nih.gov/pubmed/16121878 PubMedPubMedCentralGoogle Scholar
  27. 27.
    Yeh CN, Chen MF, Jan YY. Laparoscopic cholecystectomy in 226 cirrhotic patients. Experience of a single center in Taiwan. Surg Endosc. 2002;16(11):1583–7. doi: 10.1007/s00464-002-9026-0.CrossRefPubMedGoogle Scholar
  28. 28.
    Azoulay D, Buabse F, Damiano I, et al. Neoadjuvant transjugular intrahepatic portosystemic shunt: a solution for extrahepatic abdominal operation in cirrhotic patients with severe portal hypertension. J Am Coll Surg. 2001;193(1):46–51. http://www.ncbi.nlm.nih.gov/pubmed/11442253 CrossRefPubMedGoogle Scholar
  29. 29.
    Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134(1):172–8. doi: 10.1378/chest.07-2331.CrossRefPubMedGoogle Scholar
  30. 30.
    Mansour N, Lentschener C, Ozier Y. Do we really need a low central venous pressure in elective liver resection. Acta Anaesthesiol Scand. 2008;52(9):1306–07. doi:AAS1750 [pii]10.1111/j.1399-6576.2008.01750.x.Google Scholar
  31. 31.
    Schroeder RA, Kuo PC. Pro: low central venous pressure during liver transplantation – not too low. J Cardiothorac Vasc Anesth. 2008;22(2):311–4. doi: 10.1053/j.jvca.2007.12.009.CrossRefPubMedGoogle Scholar
  32. 32.
    Niemann CU, Feiner J, Behrends M, Eilers H, Ascher NL, Roberts JP. Central venous pressure monitoring during living right donor hepatectomy. Liver Transpl. 2007;13(2):266–71. doi: 10.1002/lt.21051.CrossRefPubMedGoogle Scholar
  33. 33.
    Spier BJ, Larue SJ, Teelin TC, et al. Review of complications in a series of patients with known gastro-esophageal varices undergoing transesophageal echocardiography. J Am Soc Echocardiogr. 2009;22(4):396–400. doi: 10.1016/j.echo.2009.01.002.CrossRefPubMedGoogle Scholar
  34. 34.
    Myo Bui CC, Worapot A, Xia W, et al. Gastroesophageal and hemorrhagic complications associated with intraoperative transesophageal echocardiography in patients with model for end-stage liver disease score 25 or higher. J Cardiothorac Vasc Anesth. 2015;29(3):594–7. doi: 10.1053/j.jvca.2014.10.030.CrossRefPubMedGoogle Scholar
  35. 35.
    Markin NW, Sharma A, Grant W, Shillcutt SK. The safety of transesophageal echocardiography in patients undergoing orthotopic liver transplantation. J Cardiothorac Vasc Anesth. 2015;29(3):588–93. doi: 10.1053/j.jvca.2014.10.012.CrossRefPubMedGoogle Scholar
  36. 36.
    Tripodi A. Tests of coagulation in liver disease. Clin Liver Dis. 2009;13(1):55 - +. doi: 10.1016/j.cld.2008.09.002.CrossRefPubMedGoogle Scholar
  37. 37.
    Tripodi A, Primignani M, Chantarangkul V, et al. Thrombin generation in patients with cirrhosis: the role of platelets. Hepatology. 2006;44(2):440–5. doi: 10.1002/hep.21266.CrossRefPubMedGoogle Scholar
  38. 38.
    Kennedy WF, Everett GB, Cobb LA, Allen GD. Simultaneous systemic and hepatic hemodynamic measurements during high spinal anesthesia in normal man. Anesth Analg Curr Res. 1970;49(6):1016 - &. <Go to ISI>://WOS:A1970H956200026CrossRefGoogle Scholar
  39. 39.
    Kennedy WF, Everett GB, Cobb LA, Allen GD. Simultaneous systemic and hepatic hemodynamic measurements during high peridural anesthesia in normal man. Anesth Analg Curr Res. 1971;50(6):1069 - &. doi: 10.1213/00000539-197150060-00029.CrossRefGoogle Scholar
  40. 40.
    McDonnell JG, O’Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg. 2007;104(1):193–7. doi: 10.1213/01.ane.0000250223.49963.0f.CrossRefPubMedGoogle Scholar
  41. 41.
    Niraj G, Kelkar A, Jeyapalan I, et al. Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery. Anaesthesia. 2011;66(6):465–71. doi: 10.1111/j.1365-2044.2011.06700.x.CrossRefPubMedGoogle Scholar
  42. 42.
    Frink Jr EJ. The hepatic effects of sevoflurane. Anesth Analg. 1995;81(6 Suppl):S46–50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7486148 CrossRefPubMedGoogle Scholar
  43. 43.
    Schindler E, Muller M, Zickmann B, Kraus H, Reuner KH, Hempelmann G. Blood supply to the liver in the human after 1 MAC desflurane in comparison with isoflurane and halothane. Anasthesiol Intensivmed Notfallmed Schmerzther. 1996;31(6):344–8. doi: 10.1055/s-2007-995933.CrossRefPubMedGoogle Scholar
  44. 44.
    Matsumoto N, Koizumi M, Sugai M. Hepatolobectomy-induced depression of hepatic circulation and metabolism in the dog is counteracted by isoflurane, but not by halothane. Acta Anaesthesiol Scand. 1999;43(8):850–4. http://www.ncbi.nlm.nih.gov/pubmed/10492415 CrossRefPubMedGoogle Scholar
  45. 45.
    Crawford MW, Lerman J, Saldivia V, Carmichael FJ. Hemodynamic and organ blood flow responses to halothane and sevoflurane anesthesia during spontaneous ventilation. Anesth Analg. 1992;75(6):1000–6. http://www.ncbi.nlm.nih.gov/pubmed/1443679 CrossRefPubMedGoogle Scholar
  46. 46.
    Njoku D, Laster MJ, Gong DH, Eger 2nd EI, Reed GF, Martin JL. Biotransformation of halothane, enflurane, isoflurane, and desflurane to trifluoroacetylated liver proteins: association between protein acylation and hepatic injury. Anesth Analg. 1997;84(1):173–8. http://www.ncbi.nlm.nih.gov/pubmed/8989020 CrossRefPubMedGoogle Scholar
  47. 47.
    Sear JW, Prysroberts C, Dye A. Hepatic-function after anesthesia for major vascular reconstructive surgery – a comparison of 4 anesthetic techniques. Br J Anaesth. 1983;55(7):603–9. doi: 10.1093/bja/55.7.603.CrossRefPubMedGoogle Scholar
  48. 48.
    Nunn JF. Clinical aspects of the interaction between nitrous oxide and vitamin B12. Br J Anaesth. 1987;59(1):3–13. http://www.ncbi.nlm.nih.gov/pubmed/3548788 CrossRefPubMedGoogle Scholar
  49. 49.
    Parke TJ, Stevens JE, Rice AS, et al. Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. BMJ. 1992;305(6854):613–6. http://www.ncbi.nlm.nih.gov/pubmed/1393073 CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Otterspoor LC, Kalkman CJ, Cremer OL. Update on the propofol infusion syndrome in ICU management of patients with head injury. Curr Opin Anaesthesiol. 2008;21(5):544–51. doi: 10.1097/ACO.0b013e32830f44fb.CrossRefPubMedGoogle Scholar
  51. 51.
    Thompson DR. Narcotic analgesic effects on the sphincter of oddi: a review of the data and therapeutic implications in treating pancreatitis. Am J Gastroenterol. 2001;96(4):1266–72. doi: 10.1111/j.1572-0241.2001.03536.x.CrossRefPubMedGoogle Scholar
  52. 52.
    Trouvin JH, Farinotti R, Haberer JP, Servin F, Chauvin M, Duvaldestin P. Pharmacokinetics of midazolam in anesthetized cirrhotic-patients. Br J Anaesth. 1988;60(7):762–7. doi: 10.1093/bja/60.7.762.CrossRefPubMedGoogle Scholar
  53. 53.
    Macgilchrist AJ, Birnie GG, Cook A, et al. Pharmacokinetics and pharmacodynamics of intravenous midazolam in patients with severe alcoholic cirrhosis. Gut. 1986;27(2):190–5. doi: 10.1136/gut.27.2.190.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Tegeder I, Lotsch J, Geisslinger G. Pharmacokinetics of opioids in liver disease. Clin Pharmacokinet. 1999;37(1):17–40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10451781 CrossRefPubMedGoogle Scholar
  55. 55.
    Hunter JM, Parker CJ, Bell CF, Jones RS, Utting JE. The use of different doses of vecuronium in patients with liver dysfunction. Br J Anaesth. 1985;57(8):758–64. http://www.ncbi.nlm.nih.gov/pubmed/2861836 CrossRefPubMedGoogle Scholar
  56. 56.
    Magorian T, Wood P, Caldwell J, et al. The pharmacokinetics and neuromuscular effects of rocuronium bromide in patients with liver disease. Anesth Analg. 1995;80(4):754–9. http://www.ncbi.nlm.nih.gov/pubmed/7893030 PubMedGoogle Scholar
  57. 57.
    Cahill PA. Vasoconstrictor responsiveness of portal hypertensive vessels. Clin Sci. 1999;96(1):3–4. doi: 10.1042/cs19980297.CrossRefPubMedGoogle Scholar
  58. 58.
    Cahill PA, Redmond EM, Sitzmann JV. Endothelial dysfunction in cirrhosis and portal hypertension. Pharmacol Ther. 2001;89(3):273–93. doi: 10.1016/s0163-7258(01)00128-0.CrossRefPubMedGoogle Scholar
  59. 59.
    Alves de Mattos A. Current indications for the use of albumin in the treatment of cirrhosis. Ann Hepatol. 2011;10(Suppl 1):S15–20. http://www.ncbi.nlm.nih.gov/pubmed/21566250 PubMedGoogle Scholar
  60. 60.
    Bernardi M, Ricci CS, Zaccherini G. Role of human albumin in the management of complications of liver cirrhosis. J Clin Exp Hepatol. 2014;4(4):302–11. doi: 10.1016/j.jceh.2014.08.007.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Runyon BA. Management of adult patients with ascites due to cirrhosis: an update. Hepatology. 2009;49(6):2087–107. doi: 10.1002/hep.22853.CrossRefPubMedGoogle Scholar
  62. 62.
    Terg R, Gadano A, Cartier M, et al. Serum creatinine and bilirubin predict renal failure and mortality in patients with spontaneous bacterial peritonitis: a retrospective study. Liver Int. 2009;29(3):415–9. doi: 10.1111/j.1478-3231.2008.01877.x.CrossRefPubMedGoogle Scholar
  63. 63.
    Ortega R, Gines P, Uriz J, et al. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study. Hepatology. 2002;36(4 Pt 1):941–8. doi: 10.1053/jhep.2002.35819.CrossRefPubMedGoogle Scholar
  64. 64.
    Quiroga J, Sangro B, Nunez M, et al. Transjugular intrahepatic portal-systemic shunt in the treatment of refractory ascites – effect on clinical, renal, humoral, and hemodynamic parameters. Hepatology. 1995;21(4):986–94. doi: 10.1016/0270-9139(95)90245-7.PubMedGoogle Scholar
  65. 65.
    Lentschener C, Benhamou D, Mercier FJ, et al. Aprotinin reduces blood loss in patients undergoing elective liver resection. Anesth Analg. 1997;84(4):875–81. http://www.ncbi.nlm.nih.gov/pubmed/9085974 CrossRefPubMedGoogle Scholar
  66. 66.
    Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection. Br J Surg. 1998;85(8):1058–60. <Go to ISI>://WOS:000075280800006CrossRefPubMedGoogle Scholar
  67. 67.
    Franco D. Liver surgery has become simpler. Eur J Anaesthesiol. 2002;19(11):777–9. doi: 10.1017/s0265021502001254.CrossRefPubMedGoogle Scholar
  68. 68.
    Lentschener C, Ozier Y. Anaesthesia for elective liver resection: some points should be revisited. Eur J Anaesthesiol. 2002;19(11):780–8. doi: 10.1017/s0265021502001266.CrossRefPubMedGoogle Scholar
  69. 69.
    Clavien PA, Petrowsky H, DeOliveira ML, Graf R. Strategies for safer liver surgery and partial liver transplantation. N Engl J Med. 2007;356(15):1545–59. doi:356/15/1545 [pii]10.1056/NEJMra065156.
  70. 70.
    Wang W-D, Liang L-J, Huang X-Q, Yin X-Y. Low central venous pressure reduces blood loss in hepatectomy. World J Gastroenterol. 2006;12(6):935–9. <Go to ISI>://WOS:000239994700015CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Melendez JA, Arslan V, Fischer ME, et al. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg. 1998;187(6):620–5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9849736 CrossRefPubMedGoogle Scholar
  72. 72.
    Kim YK, Chin JH, Kang SJ, et al. Association between central venous pressure and blood loss during hepatic resection in 984 living donors. Acta Anaesthesiol Scand. 2009;53(5):601–6. doi: 10.1111/j.1399-6576.2009.01920.x.CrossRefPubMedGoogle Scholar
  73. 73.
    Chhibber A, Dziak J, Kolano J, Norton JR, Lustik S. Anesthesia care for adult live donor hepatectomy: our experiences with 100 cases. Liver Transpl. 2007;13(4):537–42. doi: 10.1002/lt.21074.CrossRefPubMedGoogle Scholar
  74. 74.
    Hughes MJ, Ventham NT, Harrison EM, Wigmore SJ. Central venous pressure and liver resection: a systematic review and meta-analysis. HPB. 2015;17(10):863–71. doi: 10.1111/hpb.12462.CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Seo H, Jun IG, Ha TY, Hwang S, Lee SG, Kim YK. High stroke volume variation method by mannitol administration can decrease blood loss during donor hepatectomy. Medicine (Baltimore). 2016;95(2):e2328. doi: 10.1097/MD.0000000000002328.CrossRefGoogle Scholar
  76. 76.
    Massicotte L, Perrault MA, Denault AY, et al. Effects of phlebotomy and phenylephrine infusion on portal venous pressure and systemic hemodynamics during liver transplantation. Transplantation. 2010;89(8):920–7. doi: 10.1097/TP.0b013e3181d7c40c.CrossRefPubMedGoogle Scholar
  77. 77.
    Matot I, Scheinin O, Eid A, Jurim O. Epidural anesthesia and analgesia in liver resection. Anesth Analg. 2002;95(5):1179–81. table of contents. http://www.ncbi.nlm.nih.gov/pubmed/12401587 CrossRefPubMedGoogle Scholar
  78. 78.
    Borromeo CJ, Stix MS, Lally A, Pomfret EA. Epidural catheter and increased prothrombin time after right lobe hepatectomy for living donor transplantation. Anesth Analg. 2000;91(5):1139–41. http://www.ncbi.nlm.nih.gov/pubmed/11049898 PubMedGoogle Scholar
  79. 79.
    Elterman KG, Xiong Z. Coagulation profile changes and safety of epidural analgesia after hepatectomy: a retrospective study. J Anesth. 2015;29(3):367–72. doi: 10.1007/s00540-014-1933-4.CrossRefPubMedGoogle Scholar
  80. 80.
    Barton JS, Riha GM, Differding JA, et al. Coagulopathy after a liver resection: is it over diagnosed and over treated? HPB. 2013;15(11):865–71. doi: 10.1111/hpb.12051.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Lee SH, Gwak MS, Choi SJ, et al. Prospective, randomized study of ropivacaine wound infusion versus intrathecal morphine with intravenous fentanyl for analgesia in living donors for liver transplantation. Liver Transpl. 2013;19(9):1036–45. doi: 10.1002/lt.23691.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Randolph H. Steadman
    • 1
  • Jennifer W. Nguyen-Lee
    • 1
  1. 1.Department of Anesthesiology and Perioperative MedicineUCLA Health SystemLos AngelesUSA

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