Hepatic Resection: A Challenge To Anaesthesiologist!!!

Abstract

Background: Hepatic resection is a surgery which is associated with high risk of patient’s morbidity and mortality. Thereby requiring expert skills on anaesthesia front. With the advancement in medical science there has been reduction in morbidity of patient. Starting from the assessment of the patient preoperatively for preexisting parenchymal liver disease going through the intra op period in which haemodynamic alterations can take a toll to the postoperative part , all are very crucial. Aims: 1. To study the anaesthethic strategies during perioperative period. 2. To assess the postoperative recovery phase. Methodology: This was a retrospective analysis of 10 patients with established liver disorders excluding patients with alcoholic hepatitis planned for hepatic resection in age range of 40-50yrs, under ASA grade 3. After induction of patient under epidural and general anaesthesia, haemodynamic parameters, blood loss, central venous pressure(CVP) were observed. CVP was kept ≤5mmHg. Postoperative monitoring for vitals and complications was done. Results: Out of the 10 patients,(Carcinoma GB, Hemangioma, Hydatid cyst). Two patients were not able to sustain low CVP, leading to acute transient renal failure in post operative period. Four (40%) patients needed blood transfusion. 20% patients had deranged coagulation profile which was managed by transfusion of fresh frozen plasma. Conclusion: Improvement in surgical and anesthetic skills, use of risk reduction strategies, preoperative assessment, haemodynamic management can help in better patient outcome with reduction in mortality.