ANESTHESIOLOGY FAST REVIEW

ANESTHESIOLOGY_FAST_REVIEWKAPAK1-0-25

HEPATIC SURGERY ANESTHESIA

Yusuf Furkan Güneş

Ankara Bilkent City Hospital, Department of Anesthesiology and Reanimation, Ankara, Türkiye

Güneş YF. Hepatic Surgery Anesthesia. In: Kazancı D, editor. Anesthesiology Fast Review. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.305-316.

ABSTRACT

  • Overview of Liver Surgery: Liver surgery is one of the most complex and technically demanding fields in modern medicine. The intricate anatomy of the liver, its dual blood supply, and unique physiological characteristics require a meticulous approach at every stage of surgery. Procedures are performed for both benign and malignant conditions, with notable improvements in patient survival, particularly in cases of colorectal cancer metastases and hepatocellular carcinoma. As minimally invasive techniques have advanced, complication rates have decreased, providing patients with a more comfortable recovery process.
  • Preoperative Evaluation: The success of liver surgery closely correlates with thorough preoperative assessment. Child-Pugh and MELD scores are commonly used to predict potential postoperative complications. In addition, evaluating the patient’s general health, cardiorespiratory capacity, and nutritional status are critical. Prehabilitation programs, as recommended in ERAS protocols, can help optimize patients before surgery. Detailed imaging and analysis of tumor size, location, and relationship to nearby structures is essential, and ensuring adequate future liver remnants is key to avoiding post-hepatectomy liver failure. These evaluations guide surgical strategy and significantly influence outcomes.
  • Intraoperative Management: Hepatotoxic anesthetic agents are avoided during induction and maintenance. Propofol for induction, remifentanil infusion, and volatile agents are commonly chosen. Along with standard ASA monitoring, invasive blood pressure measurement and wide-bore intravenous access are usually employed. Central venous catheterization is indicated in selected cases. Various strategies aim to minimize blood loss and maintain hemodynamic stability, including the transition from low central venous pressure (CVP) management to dynamic parameters like stroke volume variation (SVV) and pulse pressure variation (PPV). Techniques such as the Pringle maneuver and total vascular exclusion (TVE) help control bleeding while monitoring hypothermia and lactate levels remains crucial for surgical success. Balanced crystalloid solutions are generally preferred, whereas hydroxyethyl starches and colloids are used sparingly. In cases of massive hemorrhage or venous air embolism, prompt fluid resuscitation and hemodynamic support are vital.
  • Pain Management: Effective postoperative pain control is critical for patient comfort and recovery. Thoracic epidural analgesia is highly effective for open liver surgery but requires caution in patients at risk of coagulopathy. Alternatives, including intrathecal morphine or transversus abdominis plane (TAP) blocks, may also be used. Multimodal analgesia protocols offer an effective approach to pain management by reducing the need for opioids.
  • Postoperative Complications: Common postoperative complications include surgical site infections, bile leaks, and post-hepatectomy liver failure. Close monitoring and a multidisciplinary approach are essential for the early detection and management of these conditions, ultimately improving patient outcomes.

Keywords: Hepatectomy; Onco-anesthesia; Liver neoplasms; Anesthesia and analgesia; Perioperative care, Anesthesia; General.

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