4 de junho de 2013

Artigo recomendado: Anesthetic considerations during liver surgery

Imre Redai, Jean Emond, Tricia Brentjens

I. Redai et al / Surg Clin North Am 84 (2004) 401–411

Recent advances in surgical and anesthetic management have reduced the operative risk of major hepatectomies significantly. Although these advances have been multifactorial, anesthetic approaches derived from liver transplantation have had a major impact in our own practice and given us greater capacity to perform complex resections safely. We have been liberal in the use of vascular isolation techniques to prevent hemorrhage in our approach to liver surgery, a modification that mandates a high level of anesthetic expertise to manage complex liver cases [1].

Understanding the underlying pathological conditions of liver disease and the physiology of vascular exclusion and surgical resection has significantly contributed to goal-oriented anesthetic management. The recognition of the importance of expert anesthetic management for liver surgery has led to the formation of anesthesiology teams dedicated to liver surgery and transplantation in most major institutions.

Preoperative considerations
Our experience with hepatectomy over nearly 2 decades has spanned a broad range of clinical scenarios, ranging from the healthy living donor to the patient with advanced cirrhosis undergoing local excision of a malignancy. The preoperative assessment is tailored to accommodate the clinical needs of the patient, estimating the need for invasive monitoring based on the extent of resection and the general health of the patient. Otherwise healthy individuals presenting for even extensive liver surgery need no additional work-up other than routine preoperative laboratories, which include a complete blood count, serum chemistries, and plasma coagulation studies. Increasingly, patients with significant comorbidities are scheduled for major liver resections. Assessing the functional status of these patients is often a significant challenge, as very few tests are available to assess with adequate predictive power the hemodynamic, respiratory, and hepatic reserve in this population...

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