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Related Experiment Video

Updated: Jun 14, 2025

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'Fulminant hepatic failure' anesthesiologic considerations.

Luigi Vetrugno1,2, Francesco Alessandri3, Antonio Toscano4

  • 1Department of Emergency, Health Integrated Agency of Friuli Centrale, Tolmezzo.

Current Opinion in Anaesthesiology
|June 13, 2025
PubMed
Summary

Effective perioperative management of acute liver failure (ALF) involves intensive care, noninvasive intracranial pressure monitoring, and early renal replacement therapy. Coagulation assessment and hemodynamic support are critical for reducing mortality in ALF patients.

Keywords:
acute liver failurecoagulopathyencephalopathyhemodynamic monitoringrenal replacement therapy

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Area of Science:

  • Critical care medicine
  • Hepatology
  • Nephrology

Background:

  • Acute liver failure (ALF) is a complex condition with high mortality.
  • Multiorgan failure is a common complication in ALF patients.
  • Advancements in supportive care have improved outcomes for ALF patients.

Purpose of the Study:

  • To summarize the perioperative management strategies for patients with acute liver failure (ALF).
  • To highlight key interventions for mitigating fatal outcomes in ALF.
  • To provide an overview of current best practices in ALF care.

Main Methods:

  • Review of current literature on perioperative management of ALF.
  • Emphasis on intensive care unit (ICU) admission and monitoring.
  • Discussion of therapeutic interventions for specific complications.

Main Results:

  • Decreased mortality due to improved supportive care and ICU admission.
  • Preference for noninvasive intracranial pressure (ICP) monitoring (e.g., transcranial Doppler) over invasive methods.
  • Effective treatments for intracranial hypertension (ICH) include hypertonic saline and mannitol.
  • Invasive hemodynamic monitoring may be required; norepinephrine is the preferred vasopressor.
  • Early renal replacement therapy (RRT) is crucial for acute kidney injury (AKI) and hyperammonemia management.
  • Point-of-care viscoelastic tests are recommended for coagulation management over traditional lab tests.

Conclusions:

  • Rapid and aggressive management of multiorgan failure in ALF is essential.
  • Key management areas include encephalopathy, brain edema, coagulopathy, hemodynamic instability, and AKI.
  • Optimized perioperative care significantly reduces the risk of fatal outcomes in ALF.