Hepatic resection
Anesthesia type | |
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Airway | |
Lines and access | |
Monitors | |
Primary anesthetic considerations | |
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Intraoperative | |
Postoperative | |
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Hepatic resection involves either an open or laparoscopic approach to removal of often metastatic disease from cancer, although other pathologies requiring resection exist. In the past, hepatectomy was associated with up to 20% mortality rate. However significant improvements in surgical technique and management have resulted in large reductions in mortality and morbidity.
The surgical course includes four main phases: assessment, mobilization, parenchymal transection, and closure. Keeping central venous pressure (CVP) low through the first 3 phases is crucial in preventing excessive hemorrhage. A low CVP makes the dissection phase easier (less distended hepatic outflow), and it minimizes venous back bleeding). Following parenchymal transection, patients can be appropriately resuscitated.
Preoperative management
Patient evaluation
System | Considerations |
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Airway | |
Neurologic | |
Cardiovascular | |
Pulmonary | |
Gastrointestinal | |
Hematologic | |
Renal | |
Endocrine | |
Other |
Labs and studies
Operating room setup
Patient preparation and premedication
NPO past midnight on night prior. Some protocols include use of clear carbohydrate beverage up to 2 hours prior to surgery.
Avoid preoperative acetaminophen or gabapentin
Consider Celebrex for multimodal pain control
Consider scopolamine patch for PONV (do not give in patients with glaucoma)
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
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Position | ||
Surgical time | ||
EBL | ||
Postoperative disposition | ||
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Potential complications |