Hot topics in liver anesthesia

Anesthetic techniques for liver surgery still have many controversial issues for anesthesiologists who want to provide optimal care for their patients. There are unanswered questions: What is the best technique to prevent excessive blood loss during live donor liver dissection? What is the proper compromise of filling pressures to reduce bleeding and not compromise vital organ function? Epidural analgesia, an established method for pain relief, carries a risk of epidural hematoma formation in liver resections and especially liver transplantation because of compromised coagulation. New inhalation anesthetics would be ideal for liver surgery except for their potential for renal failure, and the IV agent propofol may have insufficient metabolism when liver function is absent. Several recent studies are reviewed to elucidate these questions.