Liver resection
Clinical Procedure
 
Aliases:
Partial hepatectomy
Hepatic resection

Topic aliases are alternate phrasings for a particular topic.


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Intraoperative bleeding can be controlled in an emergency by clamping the vascular pedicle. The "Pringle Maneuver" refl.in/76

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Low central venous pressure reduces blood loss during hepatectomy. However, this may increase the risk of venous air embolism & the potential for haemodynamic instability refl.in/78

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Options for vascular occlusion: Pringle maneuver, Total Vascular Exclusion TVE, or TVE with preservation of caval flow. See page 78-82 refl.in/7f

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In the presence of alcoholic liver disease, haemochromatosis, or non-alcoholic fatty liver disease/steatohepatitis, consider investigating for cardiomyopathy. refl.in/78

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Liver segments and their relationship to resection. refl.in/liverresect

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Reproduced from Miller's Anesthesia 7th Edition
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Avoid lower limb venous lines (may need to clamp inferior vena cava in event of bleeding)

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Intraarterial and central venous access will be required

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Tranexamic acid may help minimise blood transfusion requirements

www.ncbi.nlm.nih.gov/pmc/...
ceaccp.oxfordjournals.org...

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Drugs which might compound postoperative hepatic encephalopathy, or which rely on hepatic metabolism, should be avoided (e.g. benzodiazepines) #ref

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Intrathecal morphine is as an alternative to insertion of an epidural which may require additional attention at time of removal to ensure there is no postoperative coagulopathy

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Regular monitoring for hypocalcemia, particularly during blood transfusion, will help maintain normal coagulation

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Blood loss may be rapid & profound. Good vascular access, appropriate invasive monitoring & close support from blood bank & postoperatively from the intensive care unit are essential refl.in/78

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Acute normovolaemic haemodilution (ANH) may reduce the need for transfusion in selected patients undergoing hepatectomy. refl.in/78

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Monitor for hypoglycaemia intraoperatively and postoperatively

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High dependency unit post operatively #ref

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The Pringle manoeuvre is usually well tolerated but if combined with caval clamping profound changes in venous return & cardiac output will occur. refl.in/78 #ref

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Post operative coagulopathy is common, may need to remove epidurals under fresh frozen plasma (FFP) cover

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Thromboelastography TEG patterns refl.in/f

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