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General Anesthesia: Overview

General Anesthesia: Overview

Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...

Parenteral Anesthetics: Overview

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.

Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy

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Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...

Local Anesthetics: Clinical Application as Spinal Anesthesia

Local Anesthetics: Clinical Application as Spinal Anesthesia

Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
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Laparoscopic Anatomical Liver Segment VII Resection with Liver Parenchymal Transection Following a Priority Approach

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Anaesthesia for Hepatic Resection Surgery.

Anton Krige¹, Leigh J S Kelliher²

¹Department of Anaesthesia and Critical Care, Royal Blackburn Teaching Hospital, Haslingden Road, Blackburn BB2 3HH, UK.

Anesthesiology Clinics

|March 3, 2022

Summary

This article details perioperative management for colorectal cancer liver metastases (CLRMs) using Enhanced Recovery After Surgery (ERAS) protocols. It covers surgical techniques, patient selection, and postoperative care to improve outcomes for liver resection patients.

Keywords:

ERAS Enhanced recovery Hepatic resection surgery Pancreatic resection surgery Whipple’s procedure

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Area of Science:

Oncology
Surgical Gastroenterology
Anesthesiology

Background:

Colorectal cancer (CRC) frequently metastasizes to the liver (CLRMs), making liver resection a critical treatment modality.
The Enhanced Recovery After Surgery (ERAS) paradigm offers a multimodal approach to optimize patient recovery.
Effective perioperative management is crucial for improving outcomes in patients undergoing hepatic resection for CLRMs.

Purpose of the Study:

To provide a comprehensive overview of the perioperative management of hepatic resection for CLRMs.
To integrate the Enhanced Recovery After Surgery (ERAS) principles into the care of these patients.
To discuss recent advancements in surgical, anesthetic, and supportive care relevant to liver resection.

Main Methods:

Review of epidemiology, outcomes, surgical history, and anatomy relevant to CLRMs.
Detailed discussion of preoperative assessment, including patient selection and liver functional status.
Exploration of intraoperative strategies for hemorrhage control and anesthetic techniques.
Outline of postoperative complication management and analgesic options.
Synthesis of current evidence supporting ERAS protocols in hepatic resection.

Main Results:

Hepatic resection is a key intervention for colorectal cancer liver metastases.
ERAS protocols can enhance recovery and potentially reduce complications after liver surgery.
Advances in surgical and anesthetic techniques aim to minimize intraoperative risks.
Comprehensive preoperative and postoperative care is essential for successful outcomes.

Conclusions:

Optimized perioperative management, incorporating ERAS, is vital for patients undergoing hepatic resection for CLRMs.
Multidisciplinary care focusing on patient selection, surgical technique, and recovery pathways improves outcomes.
Continued research and implementation of ERAS principles are essential for advancing care in this patient population.