Anesthesia for the Patient with Severe Liver Failure

Aidan Spring; Jagroop S Saran; Sinead McCarthy; Stuart A McCluskey

doi:10.1016/j.anclin.2019.10.002

Anesthesia for the Patient with Severe Liver Failure

Anesthesiol Clin. 2020 Mar;38(1):35-50. doi: 10.1016/j.anclin.2019.10.002. Epub 2020 Jan 3.

Authors

Aidan Spring¹, Jagroop S Saran¹, Sinead McCarthy¹, Stuart A McCluskey²

Affiliations

¹ Abdominal Organ Transplantation Anesthesia Fellowship Program, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, 3 Eaton North, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
² Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, 3 Eaton North, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. Electronic address: Stuart.McCluskey@uhn.ca.

PMID: 32008656
DOI: 10.1016/j.anclin.2019.10.002

Abstract

The incidence of liver failure continues to increase, and it is associated with increased perioperative morbidity and mortality. Liver failure is associated with multiorgan dysfunction, including central nervous, cardiac, respiratory, gastrointestinal, renal, and hematological systems. Preoperative identification, optimization, and tailored anesthetic management are essential for optimum outcomes in patients with liver disease undergoing surgery. The coagulopathy of liver failure is a balanced coagulopathy better assessed by thromboelastography than conventional testing, and it is not directly associated with bleeding risk.

Keywords: Anesthesia; Anesthesia considerations; End-stage liver disease; Liver failure.

Publication types

Review

MeSH terms

Abdomen / surgery
Anesthesia / methods*
Blood Coagulation
Cardiac Surgical Procedures
Humans
Liver Failure / complications*
Monitoring, Intraoperative
Pain, Postoperative / prevention & control
Wounds and Injuries / surgery