Skip to main content

Anesthesia and Intraoperative Management in Liver Surgery

  • Chapter
Benign Tumors of the Liver

Abstract

Hepatic surgery, even for benign tumors, may be considered a great challenge for the anesthetist. The role of the anesthetist in this surgery is really important, and success is a consequence of a careful evaluation of both the patient and the kind of resection that must be done together with the surgeon.

Patient’s evaluation must take into consideration not only comorbidities but also the presence of liver dysfunction, which may affect negatively the intraoperative and postoperative period.

The anesthetist must plan anesthesia according to ERAS principles in order to optimize monitoring (concerning devices, vascular access, and CVP), hemodynamics (hypovolemia, air embolism, vasopressors), ventilation (concerning protective ventilation, PEEP, and oxygenation), and pain management (blended anesthesia with epidural, spinal, or paravertebral thoracic block, TAP block, and morphine).

These are the main topics which will be discussed in this chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Jarnagin WR, Gonen M, Fong Y et al (2003) Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 236:397–406

    Article  Google Scholar 

  2. Eagle KA, Berger PB, Calkins H, Chaitman BR et al (2002) ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery – Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesth Analg 94(5):1052–1064.

    Google Scholar 

  3. Kaiser AB (1986) Antimicrobial prophylaxis in surgery. N Engl J Med 315:1129–1138

    Article  CAS  PubMed  Google Scholar 

  4. Wu CC, Yeh DC, Lin MC, Liu TJ, P’eng FK (1998) Prospective randomized trial of systemic antibiotics in patients undergoing liver resection. Br J Surg 85:489–493

    Article  CAS  PubMed  Google Scholar 

  5. Lentschener C, Ozier Y (2002) Anaesthesia for elective liver resection: some points should be revisited. Eur J Anaesthesiol 19:780–788

    Article  CAS  PubMed  Google Scholar 

  6. Botero M, Lobato EB (2001) Advances in noninvasive cardiac monitoring: an update. J Cardiothorac Vasc Anaesth 15:631–640

    Article  CAS  Google Scholar 

  7. Smyrniotis V, Kostopanagiotou G, Theodoraki K, Tsantoulas D, Contis JC (2004) The role of central venous pressure and type of vascular control in blood loss during major liver resections. Am J Surg 187(3):398–402

    Article  PubMed  Google Scholar 

  8. Redai I, Emond J, Brentjens T (2004) Anesthetic considerations during liver surgery. Surg Clin North Am 84:401–411

    Article  PubMed  Google Scholar 

  9. Servin FS, Lavaut E, Kleef U, Desmonts JM (1996) Repeated doses of rocuronium bromide administered to cirrhotic and control patients receiving isoflurane. A clinical and pharmacokinetic study. Anesthesiology 84:1092–2000

    Article  CAS  PubMed  Google Scholar 

  10. Dershwitz M, Hoke JF, Rosow CE et al (1996) Pharmacokinetics and pharmacodynamics of remifentanil in volunteers subjects with severe liver disease. Anesthesiology 84:812–820

    Article  CAS  PubMed  Google Scholar 

  11. Gatecel C, Losser MR, Payen D (2003) The postoperative effects of halothane versus isoflurane on hepatic artery and portal vein blood flow in humans. Anesth Analg 96(3):740–745

    Article  CAS  PubMed  Google Scholar 

  12. Beck-Schimmer B, Breitenstein S, Urech S et al (2008) A randomized controlled trial on pharmacological preconditioning in liver surgery using a volatile anesthetic. Ann Surg 248(6):909–916

    Article  PubMed  Google Scholar 

  13. Maze M, Bass NM (2000) Anesthesia and the hepatobiliary system. In: Miller RD (ed) Anesthesia, 5th edn. Churchill Livingstone, London, pp 1960–1972

    Google Scholar 

  14. Hart SR, Bordes B, Hart J, Corsino D, Harmon D (2011) Unintended perioperative hypothermia. Ochsner J 11(3):259–270

    PubMed Central  PubMed  Google Scholar 

  15. Hervé P, Lebrec D, Brenot F, Simonneau G, Humbert M, Sitbon O et al (1998) Pulmonary vascular disorders in portal hypertension. Eur Respir J 11(5):1153–1166

    Article  PubMed  Google Scholar 

  16. Severgnini P, Selmo G, Lanza C, Chiesa A, Frigerio A, Bacuzzi A, Dionigi G, Novario R, Gregoretti G, de Abreu MG, Schulz MJ, Jaber S, Futier E, Chiaranda M, Pelosi P (2013) Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function. Anesthesiology 118(6):1307–1321

    Article  CAS  PubMed  Google Scholar 

  17. Regli A, Mahendran R, Fish ET, Roberts B, Noffsinger B, De Keulenar BR, Singh B, Van Heerden PV (2012) Matching positive end-expiratory pressure to intra-abdominal pressure improves oxygenation in a porcine sick lung model of intra-abdominal pressure. Crit Care 16:R208

    Article  PubMed Central  PubMed  Google Scholar 

  18. Jones RM, Moulton CE, Hardy KJ (1998) Central venous pressure and its effect on blood loss during liver resection. Br J Surg 85:1058–1060

    Article  CAS  PubMed  Google Scholar 

  19. Kooby DA, Stockman J, Ben-Porat L et al (2003) Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg 237:860–869

    PubMed Central  PubMed  Google Scholar 

  20. Koo BN, Kil HK, Choi JS, Kim JY, Chun DH, Hong YW (2005) Hepatic resection by the Cavitron Ultrasonic Surgical Aspirator increases the incidence and severity of venous air embolism. Anesth Analg 101(4):966–970, table of contents

    Article  PubMed  Google Scholar 

  21. Torossian A (2008) Thermal management during anaesthesia and thermoregulation standards for the prevention of inadvertent perioperative hypothermia. Best Pract Res Clin Anaesthesiol 22(4):659–668

    Article  PubMed  Google Scholar 

  22. Borromeo CJ, Stix MS, Lally A, Pomfret EA (2000) Epidural catheter and increased prothrombin time after right lobe hepatectomy for living donor transplantation. Anesth Analg 91(5):1139–1141

    CAS  PubMed  Google Scholar 

  23. Siniscalchi A, Begliomini B, De Pietri L, Braglia V, Gazzi M, Masetti M, Di Benedetto F, Pinna AD, Miller CM, Pasetto A (2004) Increased prothrombin time and platelet counts in living donor right hepatectomy: implications for epidural anesthesia. Liver Transpl 10(9):1144–1149

    Article  PubMed  Google Scholar 

  24. Roy JD, Massicotte L, Sassine MP, Seal RF, Roy A (2006) A comparison of intrathecal morphine/fentanyl and patient-controlled analgesia with patient-controlled analgesia alone for analgesia after liver resection. Anesth Analg 103:990–994

    Article  CAS  PubMed  Google Scholar 

  25. Matot I, Scheinin O, Eid A, Jurim O (2002) Epidural anesthesia and analgesia in liver resection. Anesth Analg 95:1179–1181

    Article  PubMed  Google Scholar 

  26. Nishikawa K, Kimura S, Shimodate Y, Igarashi M, Namiki A (2007) A comparison of intravenous-based and epidural-based techniques for anesthesia and postoperative analgesia in elderly patients undergoing laparoscopic cholecystectomy. J Anesth 21(1):1–6

    Article  PubMed  Google Scholar 

  27. Ko JS, Choi SJ, Gwak MS, Kim GS, Ahn HJ, Kim JA, Hahm TS, Cho HS, Kim KM, Joh JW (2009) Intrathecal morphine combined with intravenous patient-controlled analgesia is an effective and safe method for immediate postoperative pain control in live liver donors. Liver Transpl 15(4):381–389. doi:10.1002/lt.21625

    Article  PubMed  Google Scholar 

  28. Ho AM-H, Karmakar MK, Cheung M, Lam GCS (2004) Right thoracic paravertebral analgesia for hepatectomy. Br J Anaesth 93(3):458–461

    Article  PubMed  Google Scholar 

  29. Luyet C, Siegenthaler A, Szucs-Farkas Z, Hummel G, Eichenberger U, Vogt A (2012) The location of paravertebral catheters placed using the landmark technique. Anaesthesia 67(12):1321–1326

    Article  CAS  PubMed  Google Scholar 

  30. De Pietri L, Siniscalchi A, Reggiani A, Masetti M, Begliomini B, Gazzi M, Gerunda GE, Pasetto A (2006) The use of intrathecal morphine for postoperative pain relief after liver resection: a comparison with epidural analgesia. Anesth Analg 102(4):1157–1163

    Article  PubMed  Google Scholar 

  31. Cole PJ, Craske DA, Wheatley RG (2000) Efficacy and respiratory effects of low-dose spinal morphine for postoperative analgesia following knee arthroplasty. Br J Anaesth 85(2):233–237

    Article  CAS  PubMed  Google Scholar 

  32. Børglum J, Maschmann C, Belhage B, Jensen K (2011) Ultrasound-guided bilateral dual transversus abdominis plane block: a new four-point approach. Acta Anaesthesiol Scand 55(6):658–663

    Article  PubMed  Google Scholar 

  33. Siddiqui MR, Sajid MS, Uncles DR, Cheek L, Baig MK (2011) A meta-analysis on the clinical effectiveness of transversus abdominis plane block. J Clin Anesth 23(1):7–14

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Raffaella Reineke .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing AG Switzerland

About this chapter

Cite this chapter

Reineke, R., di Prima, A.L., Beretta, L. (2015). Anesthesia and Intraoperative Management in Liver Surgery. In: Aldrighetti, L., Cetta, F., Ferla, G. (eds) Benign Tumors of the Liver. Springer, Cham. https://doi.org/10.1007/978-3-319-12985-3_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-12985-3_23

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-12984-6

  • Online ISBN: 978-3-319-12985-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics