Hepatic resection

Hepatic resection

Anesthesia type
Airway
Lines and access
Monitors
Primary anesthetic considerations
Preoperative
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
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

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)

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications