Perioperative liver protection.
OBJECTIVE
This review presents important pathophysiological alterations associated with impaired liver function and discusses protective perioperative strategies and the various anaesthetic agents recommended.


RESULTS
Perioperative liver impairment is a serious complication of anaesthesia and surgery. Unfortunately, clinicians are provided with only crude macrohaemodynamic monitoring devices to optimize their therapy. Technical improvements have revealed some complex mysteries of perioperative microcirculatory alterations and have disclosed a large heterogeneity between different vascular beds. The present review will critically discuss current clinical concepts of optimizing global haemodynamic variables and the often contrasting effects of vasoactive agents on the microcirculatory nutritional blood flow. Finally, promising protective experimental interventions of pharmacological or ischaemic preconditioning are presented and their often disillusioning transition into recent clinical trials is highlighted.


CONCLUSIONS
Targeted perioperative liver protection still lacks adequate monitoring tools and is currently based on optimization of global haemodynamic variables. While there is currently no evidence suggesting a positive effect of ischaemic preconditioning, promising experimental results of pharmacological preconditioning and therapeutic hypothermia require further evaluation in larger randomized clinical trials.
Department of Anaesthesiology, University Hospital Duesseldorf, Duesseldorf, Germany.
Christopher
C
Beck
Ingo
I
Schwartges
Olaf
O
Picker
D000758:Anesthesia / Q000009:adverse effects*; D000777:Anesthetics / Q000009:adverse effects; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced* / Q000517:prevention & control; D008099:Liver / Q000473:pathology / Q000601:surgery*; D008107:Liver Diseases / Q000209:etiology* / Q000517:prevention & control; D008111:Liver Function Tests
D000777:Anesthetics