Anesthetic management of hepatic transplantation.
OBJECTIVE
The present review describes new trends and ongoing controversies in the anesthetic care of liver transplant recipients.


RESULTS
Recent studies have improved our knowledge of conditions increasing perioperative risk, such as portopulmonary hypertension and renal failure. Improved surgical and anesthetic management has reduced intraoperative blood loss, as more studies identify an independent association between blood transfusion and poor outcome. New concepts in the coagulopathy of liver failure are emerging, with clear implications for clinical practice, including greater awareness of the risks of intraoperative thromboembolism. Less invasive intraoperative hemodynamic monitoring has been advocated, as has wider use of transoesophageal echocardiography. Early extubation is becoming more routinized.


CONCLUSIONS
Anesthetic management still varies widely between liver transplant centers with little data to indicate best practice. Future research should focus on fluid replacement, prevention and treatment of coagulopathy, care of the acutely ill patient and the safety and benefits of early extubation.
Ozier
Yves
Y
Department of Anesthesia and Critical Care, Paris Descartes University, Hopital Cochin, Paris, France. yves.ozier@cch.aphp.fr
Klinck
John R
JR
D000768:Anesthesia, General / Q000379:methods* / Q000592:standards / Q000639:trends; D001778:Blood Coagulation Disorders / Q000517:prevention & control*; D001803:Blood Transfusion / Q000379:methods; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology / Q000517:prevention & control; D017093:Liver Failure / Q000517:prevention & control*; D016031:Liver Transplantation / Q000592:standards*; D016343:Monitoring, Intraoperative / Q000379:methods / Q000592:standards; D011300:Preoperative Care / Q000379:methods*