%0 Journal Article
%T Anesthetic Considerations in Hepatectomies under Hepatic Vascular Control
%A Aliki Tympa
%A Kassiani Theodoraki
%A Athanassia Tsaroucha
%A Nikolaos Arkadopoulos
%A Ioannis Vassiliou
%A Vassilios Smyrniotis
%J HPB Surgery
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/720754
%X Background. Hazards of liver surgery have been attenuated by the evolution in methods of hepatic vascular control and the anesthetic management. In this paper, the anesthetic considerations during hepatic vascular occlusion techniques were reviewed. Methods. A Medline literature search using the terms ¡°anesthetic,¡± ¡°anesthesia,¡± ¡°liver,¡± ¡°hepatectomy,¡± ¡°inflow,¡± ¡°outflow occlusion,¡± ¡°Pringle,¡± ¡°hemodynamic,¡± ¡°air embolism,¡± ¡°blood loss,¡± ¡°transfusion,¡± ¡°ischemia-reperfusion,¡± ¡°preconditioning,¡± was performed. Results. Task-orientated anesthetic management, according to the performed method of hepatic vascular occlusion, ameliorates the surgical outcome and improves the morbidity and mortality rates, following liver surgery. Conclusions. Hepatic vascular occlusion techniques share common anesthetic considerations in terms of preoperative assessment, monitoring, induction, and maintenance of anesthesia. On the other hand, the hemodynamic management, the prevention of vascular air embolism, blood transfusion, and liver injury are plausible when the anesthetic plan is scheduled according to the method of hepatic vascular occlusion performed. 1. Introduction Hepatectomy is one of the therapies available for benign and malignant liver disease. Although liver resections have been associated with high mortality and morbidity rates, recent advances in anesthetic and surgical management have significantly reduced the operative risk. The techniques of vascular control during hepatectomy are highly demanding and should be performed under special anesthetic considerations. Hepatic vascular control methods can be categorized as those involving occlusion of liver inflow and those involving occlusion of both liver inflow and outflow. They can be summarized as following.(1)Inflow vascular occlusion.(A)Hepatic pedicle occlusion:(a)Continuous Pringle maneuver (CPM),(b)intermittent Pringle maneuver (IPM).(B)Selective inflow occlusion.(2)Inflow and outflow vascular exclusion(A) Total hepatic vascular exclusion (THVE),(B) inflow occlusion with extraparenchymal control of the major hepatic veins: with selective hepatic vascular exclusion (SHVE). When performing these techniques, the conduct of anesthesia should take into account hemodynamic management, risks of vascular air embolism, ischemia reperfusion liver injury, intraoperative blood loss, and the need for transfusion, factors which usually complicate hepatic vascular control methods. Special attention should also be paid to the preoperative assessment and induction of anesthesia, as patients undergoing liver resection
%U http://www.hindawi.com/journals/hpb/2012/720754/