Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword
- Section I Basic sciences
- Section II Anaesthesia and peri-operative care for surgical specialties
- Chapter 7 Cardiothoracic cases
- Chapter 8 Colorectal cases
- Chapter 9 Upper gastrointestinal cases
- Chapter 10 Hepatobiliary and pancreatic cases
- Chapter 11 Endocrine cases
- Chapter 12 Vascular cases
- Chapter 13 Organ transplant cases
- Chapter 14 Otorhinology, head and neck cases
- Chapter 15 Paediatric cases
- Chapter 16 Plastic, reconstructive and cosmetic cases
- Chapter 17 Neurosurgery cases
- Chapter 18 Trauma cases
- Chapter 19 Orthopaedic cases
- Chapter 20 Urology cases
- Chapter 21 Bariatric cases
- Section III At a glance
- List of abbreviations
- Index
Chapter 10 - Hepatobiliary and pancreatic cases
Published online by Cambridge University Press: 05 July 2014
- Frontmatter
- Contents
- List of contributors
- Foreword
- Section I Basic sciences
- Section II Anaesthesia and peri-operative care for surgical specialties
- Chapter 7 Cardiothoracic cases
- Chapter 8 Colorectal cases
- Chapter 9 Upper gastrointestinal cases
- Chapter 10 Hepatobiliary and pancreatic cases
- Chapter 11 Endocrine cases
- Chapter 12 Vascular cases
- Chapter 13 Organ transplant cases
- Chapter 14 Otorhinology, head and neck cases
- Chapter 15 Paediatric cases
- Chapter 16 Plastic, reconstructive and cosmetic cases
- Chapter 17 Neurosurgery cases
- Chapter 18 Trauma cases
- Chapter 19 Orthopaedic cases
- Chapter 20 Urology cases
- Chapter 21 Bariatric cases
- Section III At a glance
- List of abbreviations
- Index
Summary
Anaesthesia for hepatobiliary surgery is complicated by both the complex nature of the surgery and by the underlying condition of the patient that may have contributed to the need for surgery. A liver resection on an otherwise fit and healthy individual with an isolated adenoma is very different to that on a cirrhotic patient. Therefore it is important not only to optimise these patients prior to surgery, but also to take into account the potential risk of post-operative liver dysfunction as a consequence of anaesthesia or surgery.
Pre-operative factors
Assessment of the patient
As with any field of medicine, a thorough history and examination is important. Patients undergoing any type of surgery have to be individually assessed, taking into account their co-morbidities. Pre-existing liver dysfunction needs not only greater assessment but also considerable multi-disciplinary input to ensure a favourable outcome. This group of patients are at significant risk of multi-organ failure and post-operative liver failure. The advent of pre-operative assessment clinics which are nurse-led with anaesthetic support has meant that potential problems can be identified and dealt with prior to day of surgery admission. All patients with chronic liver disease or undergoing a hepatectomy should have the standard pre-operative work-up including full blood count, urea and electrolytes, glucose, liver function tests and prothrombin time performed. Patients with portal hypertension undergoing hepatic resection should have their portal pressures measured (see below).
- Type
- Chapter
- Information
- A Surgeon's Guide to Anaesthesia and Peri-operative Care , pp. 116 - 124Publisher: Cambridge University PressPrint publication year: 2014