Advertisement

Perioperative Critical Care of the Patient with Liver Disease Undergoing Nonhepatic Surgery

Chapter

Abstract

Liver injury results from myriad insults including hepatotoxins and viral infections and congenital abnormalities. Individually or in combination these insults result in liver dysfunction which progresses to liver failure which causes multiple organ systems dysfunction and failure, which further impair liver function and result in death. The severity of liver dysfunction and risk of death calculations can be discerned by assessment of extrahepatic organ function. In addition to addressing individual and population benefit from liver transplantation, risk assessment by MELD can be used to address the risks of nonhepatic surgery. Furthermore, mitigation of liver injury and extrahepatic organ system dysfunction can prolong survival. In particular, attention to hemodynamics to optimize hepatic and renal perfusion and avoiding iatrogenic (ventilator-induced) lung injury and minimizing neuro-intoxicants are key to managing the patient with liver disease who is to undergo nonhepatic surgery.

Keywords

Liver failure Cirrhosis Surgery (nonhepatic) Hepatic encephalopathy Acuity scoring (APACHE, acute physiology and chronic health evaluation; MELD, model for end-stage liver disease) Lung injury (ALI; ARDS, acute respiratory distress syndrome) Acute kidney injury (AKI; ATN, acute tubular necrosis) Portal hypertension 

References

  1. 1.
    Farnsworth N, Fagan SP, Berger DH, Awad SS. Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients. Am J Surg. 2004;188(5):580–3.CrossRefPubMedGoogle Scholar
  2. 2.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.CrossRefPubMedGoogle Scholar
  3. 3.
    Sato M, Tateishi R, Yasunaga H, Horiguchi H, Matsui H, Yoshida H, Fushimi K, Koike K. The ADOPT-LC score: a novel predictive index of in-hospital mortality of cirrhotic patients following surgical procedures based on a national survey. Hepatol Res. 2016: 1–9.Google Scholar
  4. 4.
    Teh SH, Nagorney DM, Stevens SR, Offord KP, Therneau TM, Plevak DJ, Talwalkar JA, Kim WR, Kamath PS. Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology. 2007;132(4):1261–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Havens JM, Columbus AB, Olufajo OA, Askari R, Salim A, Christopher KB. Association of model for end-stage liver disease score with mortality in emergency general surgery patients. JAMA Surg. 2016;151:e160789.CrossRefPubMedGoogle Scholar
  6. 6.
    Fede G, Privitera G, Tomaselli T, Spadaro L, Purrello F. Cardiovascular dysfunction in patients with liver cirrhosis. Ann Gastroenterol. 2015;28(1):31–40.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Biancofiorea G, Mandell MS, Della RG. Perioperative considerations in patients with cirrhotic cardiomyopathy. Curr Opin Anaesthesiol. 2010;23:128–32.CrossRefGoogle Scholar
  8. 8.
    Harry R, Auzinger G, Wendon J. The clinical importance of adrenal insufficiency in acute hepatic dysfunction. Hepatology. 2002;36:395–402.CrossRefPubMedGoogle Scholar
  9. 9.
    Tsai MH, Peng YS, Chen YC, Liu NJ, Ho YP, Fang JT, Lien JM, Yang C, Chen PC, Wu CS. Adrenal insufficiency in patients with cirrhosis, severe sepsis and septic shock. Hepatology. 2006;43:673–81.CrossRefPubMedGoogle Scholar
  10. 10.
    Doleman B, Heinink TP, Read DJ, Faleiro RJ, Lund JN, Williams JP. A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain. Anaesthesia. 2015;70:1186–204.CrossRefPubMedGoogle Scholar
  11. 11.
    Parsa AA, Sprouse-Blum AS, Jackowe DJ, Lee M, Oyama J, Parsa FD. Combined preoperative use of celecoxib and gabapentin in the management of postoperative pain. Aesthetic Plast Surg. 2009;33:98–103.CrossRefPubMedGoogle Scholar
  12. 12.
    Nishiyama T, Fujimoto T, Hanaoka K. A comparison of liver function after hepatectomy in cirrhotic patients between sevoflurane and isoflurane in anesthesia with nitrous oxide and epidural block. Anesth Analg. 2004;98:990–3.CrossRefPubMedGoogle Scholar
  13. 13.
    Yin Y, Yan M, Zhu T. Minimum alveolar concentration of sevoflurane in rabbits with liver fibrosis. Anesth Analg. 2012;114:561–5.CrossRefPubMedGoogle Scholar
  14. 14.
    The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–8.CrossRefGoogle Scholar
  15. 15.
    Talmor D, Sarge T, Malhotra A, O’Donnell CR, Ritz R, Lisbon A, Novack V, Loring SH. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med. 2008;359:2095–104.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Peng S, Plank LD, McCall JL, Gillanders LK, McIlroy K, Gane EJ. Body composition, muscle function, and energy expenditure in patients with liver cirrhosis: a comprehensive study. Am J Clin Nutr. 2007;85:1257–66.PubMedGoogle Scholar
  17. 17.
    Giusto M, Lattanzi B, Albanese C, Galtieri A, Farcomeni A, Giannelli V, Lucidi C, Di Martino M, Catalano C, Merli M. Sarcopenia in liver cirrhosis: the role of computed tomography scan for the assessment of muscle mass compared with dual-energy X-ray absorptiometry and anthropometry. Eur J Gastroenterol Hepatol. 2015;27:328–34.CrossRefPubMedGoogle Scholar
  18. 18.
    Carias S, Castellanos AL, Vilchez V, Nair R, Dela Cruz AC, Watkins J, Barrett T, Trushar P, Esser K, Gedaly R. Nonalcoholic steatohepatitis is strongly associated with sarcopenic obesity in patients with cirrhosis undergoing liver transplant evaluation. J Gastroenterol Hepatol. 2016;31:628–33.CrossRefPubMedGoogle Scholar
  19. 19.
    Stephen A, SA MC, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, MS MC, Davanos E, Rice TW, Cresci GA, Gervasio JM, Sacks GS, Roberts PR, Compher C, the Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enteral Nutr. 2016;40(2):159–211.CrossRefGoogle Scholar
  20. 20.
    Lee WM, Hynan LS, Rossaro L, Fontana RJ, Stravitz RT, Larson AM, Davern TJ, Murray NG, McCashland T, Reisch JS, Robuck PR, the Acute Liver Failure Study Group. Intravenous N-Acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure. Gastroenterology. 2009;137:856–64.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Larsen FS, Schmidt LE, Bernsmeier C, Rasmussen A, Isoniemi H, Patel VC, Triantafyllou E, Bernal W, Auzinger G, Shawcross D, Eefsen M, Bjerring PN, Clemmesen JO, Krister Hockerstedt K, Frederiksen HJ, Hansen BA, Antoniades CG, Wendon J. High-volume plasma exchange in patients with acute liver failure: an open randomised controlled trial. J Hepatol. 2016;64:69–78.CrossRefPubMedGoogle Scholar
  22. 22.
    Sen S, Mookerjee RP, Cheshire LM, Davies NA, Williams R, Jalan R. Albumin dialysis reduces portal pressure acutely in patients with severe alcoholic hepatitis. J Hepatol. 2005;43:142–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Azoulay D, Buabse F, Damiano I, Smail A, Ichai P, Dannaoui M, 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;193:46–51.CrossRefPubMedGoogle Scholar
  24. 24.
    Vinet E, Perreault P, Bouchard L, Bernard D, Wassef R, Richard C, et al. Transjugular intrahepatic portosystemic shunt before abdominal surgery in cirrhotic patients: a retrospective, comparative study. Can J Gastroenterol. 2006;20:401–4.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    De Pietri L, Bianchini M, Montalti R, De Maria N, Di Maira T, Begliomini B, Gerunda GE, di Benedetto F, Garcia-Tsao G, Villa E. Thrombelastography-guided blood product use before invasive procedures in cirrhosis with severe coagulopathy: a randomized, controlled trial. Hepatology. 2016;63:566–73.CrossRefPubMedGoogle Scholar
  26. 26.
    Gunawan B, Runyon B. The efficacy and safety of ε-aminocaproic acid treatment in patients with cirrhosis and hyperfibrinolysis. Aliment Pharmacol Ther. 2006;23:115–20.CrossRefPubMedGoogle Scholar
  27. 27.
    Pungpapong S, Alvarez S, Hellinger WC, Kramer DJ, Willingham DL, Mendez JC, Nguyen JH, Hewitt WR, Aranda-Michel J, Harnois DM, Rosser BG, Hughes CB, Grewal HP, Satyanrayana R, Dickson RC, Steers JL, Keaveny AP. Peritonitis after liver transplantation: incidence, risk factors, microbiology profiles, and outcome. Liver Transpl. 2006;12(8):1244–52.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Aurora Critical Care ServiceAurora Health CareMilwaukeeUSA
  2. 2.University of Wisconsin School of Medicine and Public HealthMadisonUSA

Personalised recommendations