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Laparoscopic Anatomic S7+S8d Resection Preserving Inferior Right Hepatic Vein and S6 with Right Hepatic Vein Transection
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Perioperative liver protection.

Christopher Beck1, Ingo Schwartges, Olaf Picker

  • 1Department of Anaesthesiology, University Hospital Duesseldorf, Duesseldorf, Germany.

Current Opinion in Critical Care
|February 6, 2010
PubMed
Summary

Optimizing perioperative liver protection requires better monitoring tools. While pharmacological preconditioning shows promise, more research is needed for effective strategies against liver impairment during anesthesia and surgery.

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Area of Science:

  • Anesthesiology
  • Hepatology
  • Surgical Complications

Background:

  • Perioperative liver impairment is a significant complication of anesthesia and surgery.
  • Current macrohaemodynamic monitoring is insufficient for optimizing therapy.
  • Microcirculatory alterations during the perioperative period are complex and heterogeneous.

Purpose of the Study:

  • To review pathophysiological changes in liver function during the perioperative period.
  • To discuss protective perioperative strategies and recommended anesthetic agents.
  • To critically evaluate current concepts in hemodynamic optimization and the impact of vasoactive agents on microcirculatory blood flow.

Main Methods:

  • Literature review of pathophysiological alterations.
  • Critical discussion of clinical concepts for hemodynamic optimization.
  • Presentation of experimental protective interventions (pharmacological/ischemic preconditioning).

Main Results:

  • Perioperative liver impairment poses a serious risk.
  • Existing monitoring tools are inadequate for targeted liver protection.
  • Vasoactive agents have variable effects on microcirculatory blood flow.
  • Ischemic preconditioning has shown no positive clinical effect to date.

Conclusions:

  • Targeted perioperative liver protection is limited by inadequate monitoring.
  • Optimization relies on global hemodynamic variables.
  • Pharmacological preconditioning and therapeutic hypothermia show potential but require further clinical trials.
  • Ischemic preconditioning lacks evidence of benefit.