[Anesthesia for a patient with a giant hepatoma associated with severe acute hepatic damage]

We gave anesthesia to a patient for extensive right lobe hepatectomy. Although the liver function test revealed acute exacerbation just before the operation, we carried out anesthesia, diagnosing it to be due to giant liver tumor. The anesthesia was maintained with nitrous oxide, oxygen and epidural anesthesia with 1.5% lidocaine or 0.25% bupivacaine. A biopump inserted between the inferior vena cava and the left basilic vein was used during the right lobe resection to maintain sufficient venous return to the right atrium during the right lobe resection. Ketone body ratio was checked frequently in order to know the remnant liver energy charge and glucose was loaded properly. The surgery and anesthesia were uneventful. The resected right lobe weighed 2380 g, with necrosis of moderate size at the posterior-inferior segment. The serum transaminase decreased markedly after operation. It is important to have accurate diagnosis before we anesthetize patients with acute hepatic damage.