Gebhard Wagener Editor Liver Anesthesiology and Critical Care Medicine Second Edition 123 Liver Anesthesiology and Critical Care Medicine Gebhard Wagener Editor Liver Anesthesiology and Critical Care Medicine Second Edition Editor Gebhard Wagener Department of Anesthesiology, Columbia University Medical Center New York, NY USA ISBN 978-3-319-64297-0 ISBN 978-3-319-64298-7 (eBook) https://doi.org/10.1007/978-3-319-64298-7 Library of Congress Control Number: 2018935600 © Springer International Publishing AG, part of Springer Nature 2012, 2018 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter 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Laurie, Ben, and Anna, who allow me to enjoy life and work, and to my parents, who contributed so much to who I am Foreword to the First Edition Liver transplantation has made remarkable progress in the 48 years since the first human liver transplant, and especially in the last 30 years, since the introduction of cyclosporine made long-term survival after liver transplantation feasible A procedure that was initially untested and experimental became routine and is now the accepted treatment for end-stage liver disease in many parts of the world About 6000 liver transplants are done in the United States every year, and graft and patient survival is excellent We are able to administer transplants to children, living related and split liver transplants, and only the shortage of organs limits the expansion of our field This progress is not only due to advances in immunosuppression, surgical techniques, or organ preservation but also due to improvements in anesthetic techniques Anesthesia care initially provided by few experts in a small number of centers proliferated and is now often standardized and protocolized Advances in anesthesiology enabled the development of surgical techniques such as caval cross-clamp or partial liver transplantation There are few procedures in which the close cooperation of surgeon and anesthesiologist is as essential for the success of the surgery and liver (transplant) surgery would have never flourished as it did without the teamwork and partnership between anesthesiologists and surgeons Within the last 20 years there has been tremendous progress in clinical research of liver transplant anesthesia that aims to reduce blood transfusions, augment organ preservation, and improve overall outcome Anesthesia for liver surgery has made a similar astounding progress and now extensive resections are conceivable that would have been impossible before Postoperative critical care medicine as a continuation of the intraoperative care is now frequently in the hands of anesthesiologists and intensivists specialized in hepatic intensive care, reflecting the increasing knowledge in this field This book aims to summarize the progress in liver anesthesiology and critical care medicine of the last 20 years and serves as a guide to those who care for patients undergoing liver transplantation and liver resections The authors are the leaders in the field of liver anesthesiology and critical care in Europe, Asia, and the United States The foundation of this book is the increasing fund of knowledge gained through clinical research as well as through the extensive clinical experience of the authors that they share with the readers vii viii Foreword to the First Edition This textbook provides the necessary background to understand the complexity of the liver and its pathophysiology It summarizes the elaborate logistics involved in donor and recipient matching in Europe and the United States and then describes the routine intraoperative management of liver transplant recipients and patients undergoing hepatic resections It addresses common comorbidities and complications and how they may affect the preoperative work-up and intraoperative management The postoperative critical care section describes the routine care after liver transplantation and resection as well as diagnosis and management of possible complications including pain management This book aims to summarize our current knowledge of liver anesthesiology and critical care It will serve as a reference for those who routinely care for patients with liver disease Those new to our exciting field will gain sufficient knowledge to successfully address many of the complex issues that may arise during liver anesthesiology and critical care medicine To those who have extensive experience in the care of patients undergoing liver (transplant) surgery this book will serve as an authoritative reference and enable an in-depth immersion into the exciting field of hepatic anesthesiology and critical care medicine Pittsburgh, PA, USA Thomas E. Starzl, MD, PhD (1926–2017) Preface to the First Edition Liver transplantation and liver surgery have made enormous strides in the last 20 years It has been transformed from an often heroic operation requiring massive amounts of blood transfusions to almost routine surgery with little blood loss in spite of increasing recipient morbidity This advancement is reflected in improved long-term mortality rates in the face of preferentially allocating more marginal organs to sicker recipients Many little steps and advances are responsible for this achievement, not least improvements of anesthetic techniques and postoperative care These little steps may not be immediately obvious but were necessary to accomplish such a progress Clinical and preclinical research in liver anesthesiology and critical care medicine in the last 10 years has thrived, and a new generation of anesthesiologists and intensive care physicians is willing to scrutinize their clinical practice using clinical research tools instead of relying only on experience This has created a fascinating and productive interaction within the small group of anesthesiologists and intensivists who care for these severely sick patients This book summarizes their current knowledge by bringing together the leading experts of our subspecialty It not only condenses a large amount of clinical research but also includes opinions and experiences when evidence is insufficient It is an in-depth review of the field and presents the current best knowledge It aims to be the definitive resource of liver anesthesiology and critical care medicine Experienced and busy practitioners will find essential information to manage complex conditions of liver disease The novice anesthesiologist or resident will be able to use this book as a thorough and comprehensive introduction to our field and rapidly gain extensive knowledge as well as obtain practical advice for those complex and scary situations that can occur so frequently during liver transplantation This book provides a comprehensive review of the pathophysiology of liver disease, pharmacology, immunology, and its implications for the anesthesiologist and intensivist Anesthesiologic and postoperative care of liver transplant recipients requires a thorough appreciation of the intricacies of liver disease and its complications Extrahepatic manifestations of liver disease are addressed in chapters separated by organ systems Routine management as well as common intra- and postoperative complications are described in detail to provide the knowledge required to care for these patients ix Preface to the First Edition x Liver transplantation is expanding internationally and a large body of work and experience originates from centers in Europe and Asia Experts from the United States, Europe, and Asia have contributed to this book to give a global perspective of liver transplant anesthesiology A separate section reviews the anesthetic and postoperative management of patients undergoing liver resection New surgical approaches have allowed us to perform more extensive and intricate resections that pose new challenges to the anesthesiologist and intensivists Surgical techniques and their physiologic repercussions are described in detail, and management strategies for routine as well as complex cases and their possible complications are offered We hope this book will alleviate the apprehension often associated with caring for these sick patients and encourage many readers to engage in liver anesthesiology and critical care medicine New York, NY, USA Gebhard Wagener, MD Preface to the Second Edition The first edition of this book was published six years ago Since then liver anesthesiology and critical care medicine has rapidly evolved in pace with new developments in surgery and transplantation Laparoscopic and laparoscopic-assisted liver surgery that was rarely used before is now routine in many centers and its use for living donor hepatectomies will greatly increase acceptance of liver graft donation Anesthetic management is very different for this type of surgery, and anesthesiologists need to understand the risks and benefits of these new technologies Left lobe living liver donation for adult recipients is now frequently used and will expand the potential donor pool and reduce the risk for morbidities for the donor This would not have been possible without a better understanding of the regulation of liver blood flow and improved treatment for early graft dysfunction in the ICU. Pain procedures have evolved and the use of novel, ultrasound-guided regional analgesic techniques improved patient comfort and recovery The advent of highly successful treatment of hepatitis C with new antiviral drugs may one day reduce the number of liver transplants However in the last six years the need for organs kept rising, resulting in lower quality grafts assigned to sicker recipients This greatly complicates the anesthetic and critical care management of these patients Liver anesthesiology and critical care medicine has matured into a subspecialty in its own right with national and international societies and meetings The anesthesiology section of the International Liver Transplant Society continues to thrive with an annual educational meeting and an extraordinarily instructive and useful educational website (https://ilts.org/ education/) Independent subspecialty societies such at the Liver Intensive Care Group of Europe (LICAGE) and the newer Society for the Advancement of Transplant Anesthesia (SATA) in the United States meet regularly to share advances in the field, develop guidelines, and facilitate scientific progress Many centers now offer fellowships in liver transplant anesthesiology and societies are currently developing fellowship guidelines to potentially gain approval by the Accreditation Council for Graduate Medical Education (ACGME) in the United States To reflect these remarkable changes in our field, all chapters in this book have been revised for this edition We also added multiple new chapters, for example, about chronic liver disease, regulation of liver blood flow, evaluation of liver function, and evidence in liver anesthesiology Among others the xi 528 Cardiovascular system caval cross-clamping, 155 response to liver transplantation, 415–417 Caspofungin, 464 Catabolism, 315 Caudate lobe, 127 Caval anastomosis, 128 end-to-side, 127 hyperkalemic patient, 128 lower, 128 side to side, 122 Caval clamp trial, 156 Caval cross-clamping, 155 cardiovascular system, 155–156 gastrointestinal system, 157 neurologic system, 157 physiological effects of, 156 pulmonary system, 156 renal system, 156–157 Caval preservation technique, 94, 122 Cavitron Ultrasonic Dissector (CUSA), 336 Cavitron Ultrasonic Tissue Aspirator (CUSA), 503 Cavoportal hemitransposition (CPHT), 131 CCA, see Cholangiocarcinoma (CCA) Ceftazidime/avibacatm, 462 Ceftopirole, MRSA, 459 Centers for Disease Control and Prevention (CDC), 24 Central neural activation, 164 Central pontine myelinolysis (CPM), 137, 324, 419 Central venous catheter (CVC), 490 Central venous pressure (CVP), 140, 150, 198, 248, 371, 379, 500 Central-line associated blood stream infections (CLABSIs), 315 Cephalosporines, 460 Cerebral astrocytes, 14 Cerebral blood flow (CBF), 260, 309 Cerebral cytotoxic edema, etiology, 307–309 Cerebral edema, 308 acute liver failure in, 307 types of, 15 Cerebral ischemia, 313 Cerebral manifestation, hepatic disease with, 325 Cerebral metabolic rate, 316 Cerebral perfusion pressure (CPP), 160, 259, 311, 319 Cerebrovascular stability, 259 Chest X-ray, 490 Child-Pugh classification, 498 Child-Turcotte-Pugh (CTP) score, 31, 74, 75, 111, 112, 392 CHLT, see Combined heart and liver transplantation (CHLT) Cholangiocarcinoma (CCA), 343 Cholangiocyte, Cholecystectomy, 128 laparoscopic vs open, 396 liver disease, 395 Cholestatic liver disease, 223 Chronic antiplatelet therapy, 351 Chronic cellular rejection, 431 Index Chronic kidney disease (CKD), 270, 498 development of, 447, 448 incidence of, 448 Chronic liver disease, 394 alcoholic liver disease, 23 ascites, 27 cirrhotic cardiomyopathy, 29 clinical presentation and complications, 26 CTP scoring system, 31 epidemiology, 22 esophageal varices, 28 etiologies, 22–23 HBV, 24 HCC, 30 HCV, 24 Hepatic hydrothorax, 27 HPS, 28 HRS, 29 MELD score, 31 NAFLD, 23 pathophysiology, 24–26 POPH, 29 portal hypertension, 27 portosystemic encephalopathy, 28 prognosis, 31 PVT, 30 SBP, 27 synthetic dysfunction, 26 treatment, 31 Chronic pain, 509, 515, 519 Chronic renal failure, chronic kidney disease (CKD), see Cirrhosis, 389, 394, 508 acute kidney injury in, 270, 272 alcoholic liver disease, 23 ascites, 27 biliary, 297 cirrhotic cardiomyopathy, 29–30 clinical presentation and complications, 26 CTP scoring system, 31 epidemiology, 22 esophageal varices, 28 etiologies, 22 HBV, 24 HCC, 30 HCV, 24 hemodynamic changes in, 283 hepatic hydrothorax, 27 HPS, 28 HRS, 29 MELD score, 31 mortality, 390 NAFLD, 23 pathophysiology, 24 POPH, 29 portal hypertension, 27 portosystemic encephalopathy, 28 postoperative complications, 390 prevalence, 22 procedure types, 390 prognosis, 31 Index pulmonary function in patients with, 294 PVT, 30 retrospective review, 390 SBP, 27 synthetic dysfunction, 26 treatment, 31–34 Cirrhotic cardiomyopathy, 29, 282 Cisatracurium, 352, 405 Citrate, 472 Citrate chelation, 419 CKD, see Chronic kidney disease (CKD) Clavien’s classification system, LDLT, 491, 492 Clichy criteria, 57 CLLT, see Combined lung–liver transplantation (CLLT) CNIs, see Calcineurin inhibitors (CNIs) CNS dysfunction, 323 Coagulation cascade and liver disease, 178 inhibition and fibrinolysis, 176 liver transplantation, 420 management, viscoelastic testing for, 150 pathophysiology of, 197 Coagulopathy, 137, 261 liver disease, 398, 399 liver transplantation, 427 perioperative correction, 399 Cold ischemia, 212 Cold ischemic time (CIT), 124, 208, 209 Combined heart and liver transplantation (CHLT), 237–238 indication for, 238 intra-operative management, 238–239 postoperative course, 240 pre-operative evaluation, 238 Combined liver kidney transplant (CLKT), 275 Combined lung–liver transplantation (CLLT), 240–241 indication for, 241 intra-operative management, 242 post-operative management, 242–243 pre-operative evaluation, 241 Compartment syndrome, 397 Computed tomography (CT) volumetry hepatectomy, 499 LDLT, 486 Confusion Assessment Method for the ICU (CAM-ICU), 422, 423 Congenital heart disease, 227 Continuous positive airway pressure (CPAP), 473 Continuous renal replacement therapy (CRRT), 52, 151, 235, 274, 277, 317 Continuous venovenous hemodialysis (CVVHD), 249, 274, 277, 453 Continuous veno-venous hemofiltration (CVVH), 259, 263 Contrast-enhanced transthoracic echocardiograph, 301 Conventional laboratory tests, 135 Conventional liver function test, 79–80, 141 Conventional technique, of orthotopic liver transplantation, 157 Coronary artery bypass grafting (CABG), 288, 396 529 Coronary artery bypass surgery, 284 Coronary artery calcification (CAC), 286 Coronary artery disease (CAD), 283–284 consequence of, 284–285 coronary stent placement, 287–288 dobutamine stress echocardiography, 285 invasive, diagnostic evaluation of, 286–287 management, 287 myocardial perfusion scan, 286 preoperative evaluation, 285 Coronary stent placement, 287 Corticosteroids, 437 adverse effects, 437 clinical use, 437 method of action, 437 Couinaud segmental anatomy, 371 Cox regression studies, 117 CPP, see Cerebral perfusion pressure (CPP) CRAB, see Carbapenem-resistant Actinetobacter baumanii (CRAB) Cranial computed tomography, 138 Creatinine, 112 Critical illness related corticosteroid insufficiency (CIRCI), 48 CRRT, see continuous renal replacement therapy (CRRT) Cryoglobulinemia, 299 Cryoprecipitate (CP), 399 CTP score, see Child-Turcotte-Pugh (CTP) score The Culture of Organs, 90 CVP, see Central venous pressure (CVP) Cyclosporine, 435 adverse effects, 436 clinical use, 436 method of action, 435 pharmacokinetics and metabolism, 435–436 therapeutic drug monitoring, 436–437 Cyclosporine A, 221 Cyst, hydatid, 340 Cystic fibrosis, 295–297 Cytoablative technique, 338 Cytochrome P450, 352 3A4 (CYP3A4), 435 2E1 (CYP2E1), 13 substrates, inducers, inhibitors of, 13–14 Cytokine, 309 Cytotoxic edema, 15, 307 D DAMPs, see Damage-associated-molecular patterns (DAMPs) Daptomycin MRSA, 458 VRE, 459 DCD, see Donation after cardiac death (DCD) 1-Deamino-8-D-arginine vasopressin (DDAVP), 200 Deceased donor liver transplantation (DDLT), 488 Deep vein thrombosis (DVT), 373, 399 surveillance for, 488–489 Dendritic cells, 9, 10 Index 530 Desmopressin, 185 Detoxification of ammonia to glutamine, 308 Dexmedetomidine, 75, 406, 424, 511–512 Diabetic keto-acidosis (DKA), 15 Diazepam, 75 Difficult-to-wean patient, 472–474 Diffusing capacity of the lung for carbon monoxide (DLCO) test, 295 Diffusion-perfusion defect, 295 Dilated cardiomyopathy, 417 Dilutional coagulopathy, 427 Direct acting agent (DAA), 441 Direct-acting antiviral drugs (DAAD), 117 Disseminated intravascular coagulation (DIC), 179, 398 Dobutamine, 286 Dobutamine stress echocardiography (DSE), 285–286 Domino liver transplantation, 131–132 Donation after cardiac death (DCD), 105, 117, 252 protocols, 97 procurements, 117 utilization of, 210 Donation Service Area (DSA), 253 Donor age, 207 Donor demographics donation after cardiac death, 210 donor age, 207–209 donor characteristics, 208 donor risk index, 210–211 malignancy, 211 number of transplants, 208 prolonged cold ischemic time, 209 seropositive donors, 209–210 steatosis, 209 Donor gamma-glutamyl transpeptidase, 103 Donor graft quality, 103 Donor hepatectomy, 500 Donor liver implantation, 127–131 distribution, resulting in regional disparities in liver allocation, 113–115 Donor management, prior to procurement, 118 Donor management goals (DMGs), 118 Donor Organ Sharing Scheme, 102–103 Donor pool, 115–118 Donor population, proportion by age, 111 Donor risk index (DRI), 117, 210, 211, 252 Donor selection, 103 Donor Service Area (DSA), 113–115 Donor’s bile duct, 130 Donors and ABO incompatibility, 264 Donor-specific antibodies (DSA), 434 Doppler ultrasound, early graft failure, 453 DRI, see Donor risk index (DRI) Drug-induced liver injury (DILI), 13, 45 Drug-related eosinophilic syndrome (DRESS), 45 DSE, see Dobutamine stress echocardiography (DSE) D-sorbitol elimination, 84 Duloxetine, 519 Duramorph, 516 Dynamic liver function test, 79, 80, 141 Dysfibrinogenemia, 398 Dysglycaemia, 315 E Early allograft dysfunction (EAD), 209, 452 Early graft failure early postoperative period, 452 management, 452 operating room, 451 risk factors, 453 small for size syndrome, 453–454 ECD, see Extended criteria donor (ECD) Echinocandin, 463 Echinococcal cyst, 340 Echinococcosis, 340 Echocardiography, 356, 417 Electrocardiogram, 420 Electrocautery, 492 Electrolyte management, liver transplantation, 419, 426 Emergency surgery, liver disease, 395 Empirical antibiotic therapy, 315 Encephalopathy, 314, 403 etiology and pathophysiology of, 307 See also specific encephalopathies End stage liver disease (ESLD), 396–398, 400, 401 Endocrine function, 16 Endogenous cannabinoids, 164 Endothelial cells, Endothelial damage, 175 Endothelial dysfunction, 180 Endothelial nitric oxide synthase (eNOS), Endothelial protein C receptor (EPCR), 177 Endothelin (ET-1), 213 End-stage liver disease (ESLD), 31, 94, 508, 509 cardiovascular changes in, 281 MMT, 513 symptoms, 512 Enflurane, 96 Enhanced recovery after surgery (ERAS) programm, 360 Enteral nutrition, 428 Enterobacteriaceae carbapenemase-producing, 461 ESBL producing, 460 Epidural analgesia, 97, 490, 491, 513 Epidural devices, 138 Epinephrine, 14 Epsilon-aminocaproic acid (EACA), 186 Epstein-Barr virus (EBV), 449 ESLD, see End-stage liver disease (ESLD) Esophageal Doppler, 355 Esophageal varices, 28 Euro-Collins, 214 European Liver Transplant Registry, 491 Eurotransplant, 103 Eurotransplant liver waiting list, 102 Everolimus, 438 adverse effect, 439 clinical use, 439 method of action, 439 Index pharmacokinetics and metabolism, 439 therapeutic drug monitoring, 439 Excessive blood loss, 377 Expanded criteria organs, 116 Expiratory positive airway pressure (EPAP), 473 Extended criteria donor (ECD), 102–105 Extended-spectrum beta-lactamase (ESBL) producing enterobacteriaceae, 460–461 Extracorporeal circuit, 127 Extracorporeal liver assist devices, 317 Extracorporeal membrane oxygenation (ECMO), 210, 477 Extracorporeal perfusion, 105 Extrahepatic biliary tract, Extrahepatic injury, 225 Extubation, guidelines, 422 F Falciform ligament, 125 Familial amyloidotic polyneuropathy (FAP), 131 Fentanyl, 510 FHF, see Fulminant hepatic failure (FHF) Fibrillation, atrial, 289 Fibrin sealant, 380 Fibrinogen, 261 Fibrinolysis, 177, 182, 398 Fibrogenic microbiome, 26 Fibrosing alveolitis, 299 Fibrosis, 24–26 Flapping tremor, 28 Fluconazole, 457, 462 Fluid management, 263, 318 Fluid restriction, 200 Fluid therapy, 357 Focal nodular hyperplasia (FNH), 341, 342 Forward flow theory, 9, 65 Fresh frozen plasma (FFP), 183, 379, 399 Fulminant hepatic failure (FHF), 123, 226, 259, 308 Functional residual capacity (FRC), 397 Fungal infections, 315 in liver transplantion, 462–463 risk factor, 456–457 Future liver remnant (FLR), 82 G Gabapentin, 512, 514 Galactose elimination, 84 Gamma-aminobutyric acid (GABA) receptors, 74 Gastro-duodenal artery (GDA), 124 Gastrointestinal (GI) tract, Gastrointestinal stress ulcers, 428 Gastrointestinal system, caval cross-clamping, 157 Genetic polymorphisms, 45 Gestational alloimmune liver disease (GALD), 226 GFR, see Glomerular filtration rate (GFR) Global enddiastolic (GEDV), 140 Glomerular filtration rate (GFR), 270, 271, 402 Glucose homeostasis, 14 531 Glucose metabolism, 136 Glutamine, 50 Glutamine synthetase (GS), 308 Glycemic control, 315 liver transplantation, 419, 427 Glycogen storage diseases (GSDs), 14, 226, 341 Glycoprotein VI, 174 Graft dysfunction, 427, 434 Graft failure, 476 diagnosis, 453 signs and symptoms, 452 treatment of, 453 Graft function evaluation, 427 signs of, 427 Graft rejection, 441–442 Graft weight to recipient body weight ratio (GWBWR), 370, 371 Graft-monitoring tools, 136 Growth hormone, 16 H Halothane, 96, 352, 405, 406 Halothane hepatitis, 405 Hanging maneuver, 500 Hanging technique, 336 HAT, see Hepatic artery thrombosis (HAT) HBV, see Hepatitis B virus (HBV) HCC, see Hepatocellular carcinoma (HCC) HCV, see Hepatitis C virus (HCV) Heart failure, 283, 289 Heart-beating donation, 92 Hemangiomas, 341 Hemodynamic changes anhepatic phase, 167 in cirrhosis, 283 dissection phase, 167 graft reperfusion, 168 neo-hepatic phase, 169 pathogenic mechanisms, 164 Hemodynamic consequences, of vascular occlusions, 352–353 Hemodynamic disturbance, and management, 166 Hemodynamic management, 357–358 Hemodynamic monitoring, 138 liver transplantation, 420 tools, 354 Hemodynamics, 352 Hemolytic uremic syndrome (HUS), 448 Hemorrhage, 342, 377, 378, 380, 383, 492–493 Hemostasis activated partial thromboplastin time, 181 alterations, 195, 196 amplification phase, 175 bleeding time, 180 coagulation cascade and liver disease, 178 desmopressin, 185 endothelial dysfunction, 180 fibrinolysis monitoring, 182 532 Hemostasis (cont.) fresh frozen plasma, 183–184 hyperfibrinolysis, 179–180 inhibition and fibrinolysis, 176–178 in liver disease, 178 lysine analogues, 186 platelet function, 179 platelet function analyzer-100, 180 platelet transfusion, 184–185 primary hemostasis, 174 procoagulant drugs, 185 propagation phase, 175, 176 prothrombin time, 180–181 recombinant factor VIIa, 186 secondary hemostasis, 174–176 thrombin generation test, 181 thromboelastography, 181 topical agents in, 187 Hepatectomies, 82 Hepatectomy, 125, 321–322, 370 CT volumetry, 499 liver protective strategy during, 499 living donor (see Living donor hepatectomy) management, 501 patient selection, 497 postoperative assessment, 501–502 pre-emptive total, 259 preoperative assessment, 497–501 right, 334 surgical techniques, 503, 504 Hepatic arterial buffer response (HABR), 383 Hepatic artery buffer, 63 Hepatic artery thrombosis (HAT), 83, 262, 428, 493 Hepatic blood flow (HBF), 163, 372 Hepatic disease, with cerebral manifestation, 325 Hepatic drug metabolism, first pass metabolism, 12 Hepatic encephalopathy, 14, 52, 227, 403, 407, 418, 426 Hepatic endothelial cells, Hepatic failure, 76 Hepatic hydrothorax, 27, 298, 400, 418, 469–470 Hepatic inflow occlusion, 352 Hepatic parenchymal transection, 336 Hepatic resection, 335, 490, 491 Hepatic reticulo-endothelial dysfunction, 400 Hepatic stellate cell (HSC), pathways of, 25 Hepatic surgery, indications for, 339–340 Hepatic vein catheterization, 509 Hepatic vein wedge pressure (HVWP), 64, 345 Hepatic veins join, Hepatic venous pressure gradient (HVPG), 27, 64, 65 Hepatitis B virus (HBV), 24, 209 Hepatitis C virus (HCV), 24, 209, 440–441 Hepatobiliary disease, 296 Hepatobiliary surgery alternatives to standard resections, 338 hepatic resection technique, 335–338 liver anatomy, 333–335 minimally invasive hepatic surgery, 338–339 Hepatocaval ligament, 127 Hepatocellular carcinoma (HCC), 12, 30–31, 106, 113, 343, 345, 441 Index Hepatocellular dysfunction, 26 Hepatocytes, 7, Hepatology, 335 Hepatomegaly, 340 Hepatoprotective method, 353 Hepatopulmonary axis, 295 Hepatopulmonary syndrome (HPS), 28–29, 300–302, 400, 475 Hepatorenal syndrome (HRS), 29, 235, 271, 282, 400–401, 418 grades of, 401 mechanisms, 401 stages of, 402 Hepatorenal syndrome-acute kidney injury (HRS-AKI) treatment algorithm, 274 Hereditary hemochromatosis, 404 Hereditary hemorrhagic telangiectasia, 298 Heterotaxy syndrome, 227 High volume in intensive care (IVOIRE) study, 56 High volume plasma exchange (HVPE), 318 Hilar dissection, 123, 126 Histidine-tryptophan-glutarate (HTK) solution, 92 HOCM, see Hypertrophic obstructive cardiomyopathy (HOCM) HPS, see Hepatopulmonary syndrome (HPS) HRS, see Hepatorenal syndrome (HRS) HUS, see Hemolytic uremic syndrome (HUS) Hydatid cystic disease, 339, 340 Hydatid sand, 341 Hydromorphone, 77, 509–510 Hydromorphone-3-glucuronide (H3G), 509 Hydroxyethyl starch (HES), 358 Hyperacute rejection, 230 Hypercalcemia, 137 Hypercholesterolemia, 283 Hypercoagulability, 398, 493 Hyperfibrinogenemia, 398 Hyperfibrinolysis, 16, 179, 197, 261, 262 Hyperglycemia, 315, 419 Hyperkalemia, 137, 248 Hyperlactatemia, in LTx patients, 136 Hypertension, 64 CNIs, 436 intracranial, 307 portal, 294 porto-pulmonary, 475 Hypertrophic obstructive cardiomyopathy (HOCM), 289–292 Hyperventilation, 314 Hypervolemic hyponatremia, 324, 419, 426 Hypnotics, 352 Hypocalcemia, 168, 419, 427 Hypofibrinogenemia, 199 Hypoglycemia, 51, 419 Hypomagnesemia, 419 Hyponatremia, 137, 323–325, 397, 398, 419 Hypoperfusion, 65 Hypotension, 237 differential diagnosis, 416 vasocontricting agents, 417 Hypothermia, 51, 137 Index artificial cellular ambience of, 212 preservation injury, 213 therapeutic, 320 Hypothermic machine perfusion (HMP), 214 advantages, 214 schematic diagram of, 215 Hypovolemia, 273, 275, 289, 290 Hypovolemic hyponatremia, 419, 426 Hypoxemia, 294, 296, 300 I ICP, see Intracranial pressure (ICP) ICU, see Intensive care unit (ICU) ICU survival, predicting, 81–82 Idiosyncratic drug reaction, 45 iHD, see Intermittent hemodialysis (iHD) Immediate post-operative extubation (IPE), 470 Immunological rejection, 431–434 Immunosuppression, 240 liver transplantation, 424–426 post liver transplantation, 440 Immunosuppressive agent, 434–435 antimetabolites, 437, 438 calcineurin inhibitors, 435, 436 corticosteroids, 437 mTOR inhibitors, 438, 439 rejection and discovery, 90 side effects, 435 Indocyanine green (ICG) clearance test, 80–82, 498 Indomethacin, 320 Induction therapy, 437, 440 Infants, anesthetic management, 227 Infectious Diseases Society of America (IDSA), 464 Inferior vena cava (IVC), 124, 155, 227 Infiltration, local, 514 Inflammation, within brain, 309 Inflammatory cytokines, activation of, 136 Inhaled nitric oxide, 475, 477 Inherited disease, 295–297 Initiation, 25 Innate immune system, 11, 52 Inosine monophosphate dehydrogenase (IMDPH), 438 Inotropes, 165, 166 Inspiratory positive airway pressure (IPAP), 473 Intensive care unit (ICU) complication prevention, 428 massive transfusion, 420 Intermittent hemodialysis (iHD), 274 International Club of Ascites (ICA), 271, 274 International Consensus Conference, 472 International normalized ratio (INR), 181, 234, 398, 452, 453 Intra-abdominal pressure (IAP), 49 Intracranial hypertension (ICH), 49, 50, 258 in acute liver failure, 307 pathophysiology, 309 preoperative management, 313 ammonia-reducing strategy, 317 extracorporeal liver assist devices, 317 533 fluid management and osmotherapy, 318–319 glycemic control, 315 ICP-targeted therapy, 313 infection prophylaxis, 315–316 nutrition, 315 plasma exchange, 318 positioning and environment, 314 sedation and neuromuscular blockade, 316 seizure prophylaxis, 316 temperature, 314–315 therapies targeting CPP, 319–320 ventilation, 314 Intracranial pressure (ICP), 138, 259, 260, 307, 313 etiology, 310 intra-operative considerations, 322 monitoring, 311, 313 strategies for treating refractory increases in, 320–322 Intrahepatic biliary tract, Intrahepatic glucose levels, 136 Intraoperative monitoring adequate oxygen delivery, 140 blood flow assessment, 141 cardiac output, 139 central venous pressure, 140 central venous saturation, 140 conventional laboratory tests, 135–136 conventional liver function test, 141 dynamic liver function test, 141 electrolyte imbalances, 137 graft function, 140–141 hemodynamic monitoring, 138–139 hemostasis and coagulation, 137–138 metabolism, 136–137 neurological monitoring, 138 positive pressure ventilation, 140 standard hemodynamic monitoring, 139 transesophageal echocardiography, 140 Intrapulmonary shunting, 295 Intrathecal morphine (ITM), 372 Intrathoracic blood volume (ITBV), 140 Intravenous (IV) fluid, LDLT, 490 Intravenous patient-controlled analgesia (IVPCA), 491 Invasive arterial pressure, 354 Invasive pain interventions, 516 Ischemia, preservation injury, 213 Ischemia/reperfusion injury (IRI), 141, 380–381 management, 353–354 mechanism of, 212–213 organ preservation and modalities, 213–215 Ischemic cholecystitis, 128 Isoflurane, 96, 352 Ito cells, 8, J Janus Kinase (JAK-2) mutation, 46 Japanese Liver Transplant Society, 491 Jugular bulb oximetry, 312 534 K Kasai portoenterostomy, 224 Kayser-Fleischer rings, 47 Kidney transplantation, breakthroughs in, 93 King’s College Criteria (KCC), 48, 56–57 Kupffer cell, 9, 10, 12 Kupffer cell dysfunction, 400, 401 L Lactate, 48, 136 Laparoscopic cholecystectomy, 396 Laparoscopic donor surgery, LDLT, 486 Laparoscopic hepatobiliary surgery, 487 Laparoscopic liver resection (LLR), 339, 360 Laparoscopic right hepatectomy, 371 Laudanosine, 405 LD, see Living donation (LD) LDLT, see Living donor liver transplantation (LDLT) Left hepatectomy (LH), 373 Left lateral hepatectomy (LL), 373 Left lobe grafts, 486, 492 Left ventricular outflow tract (LVOT) obstruction, 289 Lesions benign solid liver, 341 focal nodular hyperplasias, 341 malignant liver, 342 Lidocaine, 83, 316 Ligamentum venosum, LigaSure® device, 336 Linear transducer, 518 Linezolid, MRSA, 458 Lipid metabolism, 15 Lipopolysaccharide (LPS), 12 Liposomal amphotericin B, 457, 463 Lithium dilution cardiac output (LiDCO™) systems, 165 Liver, 12, 13 age-adjusted rates of, 30 anatomic lobules and metabolic zones, 10–11 arterial and venous circulation, cellular classification, 6–10 cellular microanatomy, coagulation and fibrinolysis, 15–16 embryology, external anatomy, 6, functions, glucose homeostasis, 14 hepatic drug metabolism first pass metabolism, 12–13 P450 system, 13 phase II and III metabolism, 13 hepatic endocrine function, 16 hepatic microanatomy, hexagonal hepatic lobule, 11 innate and adaptive immunity, 11–12 internal anatomy, 6, left lobe segments, lipid metabolism and nonalcoholic fatty liver disease, 15 macroscopic anatomy, 4–6 Index oral and allograft tolerance, 12 oxygen tension, 11 periportal zone, 11 portal hypertension, protein metabolism and hepatic encephalopathy, 14–15 Liver abscess amebic abscess, 340 hydatid cyst, 340–341 pyrogenic abscess, 340 Liver Advisory Group, 103 Liver allocation, in US, 110–113 Liver biopsy, 453 Liver cirrhosis, effect of, 71 Liver disease abdominal surgery, 395 acute, 394 ascites, 397–398 bariatric surgery, 396 cardiothoracic surgery, 396 cholecystectomy, 395 chronic, 394–395 coagulopathy, 398, 399 CTP Classification, 391, 392 elective surgery, 394 emergency surgery, 395 hemostatic alterations in, 195–197 hepatorenal syndrome, 400 hereditary hemochromatosis, 404 immediate preoperative preparation, 406–407 anesthetic induction, 407 emergence and postoperative care, 407 intraoperative monitoring/management, 407 impact on perioperative outcome, 389–391 MELD score, 392 neurologic dysfunction, 403–404 OPCAB, 396 perioperative complication, 391 pharmacokinetics, 508 pharmacologic consideration, 404–405 benzodiazepines, 406 dexmedetomidine, 406 neuromuscular blocking agents, 405 opioids, 406 propofol, 406 volatile anesthetic agents, 405 physiology, 63–64 portal pressure and hypertension, 64–65 preoperative consideration, 404 preoperative preparation, 402 prevalence, 391 pulmonary function, 399, 400 renal function evaluation, 401 scoring system, 391, 392, 394 severity and nature, 394 splanchnic, portal and hepatic venous circulation, 64 surgical procedure, 395–397 TAVR, 397 thoracic surgery, 397 vasopressin in, 65–67 Index Liver failure, 380, 383, 394 operative causes, 500 pathophysiology, 502 post hepatectomy, 344 post-donation, 493 prediction, 383 signs, 497 Liver function assessment, 74–75 early graft failure assessment, 451–453 early postoperative period, 452 management, 452–453 operating room, 451–452 small for size syndrome, 453 laboratory measures, 394 scintigraphy, 499 Liver function reserve, patient selection, 498 Liver function test, 79, 452 Liver graft exchange, 103 Liver injury, 24 Liver preservation, technical advances, 216 Liver remnant volume (LRV), 382 Liver resection, 82 cardiovacular risk assessment, 350 indications, 339 intraoperative management anesthetic agents, 351–352 esophageal Doppler, 355 fluids type, 358 hemodynamic consequences of vascular occlusions, 352 hemodynamic management, 357 hemodynamic monitoring tools, 354 hemodynamics, 352 hypnotics, 352 invasive arterial pressure, 354–355 ischemia-reperfusion injury management, 353 mechanical ventilation, 359–360 pulmonary artery catheter, 355 transfusion, 358–359 transoesophageal echocardiography, 356 liver function evaluation, 350 morbidity, 344 nutritional assessment, 351 postoperative analgesia and rehabilitation, 360 pulmonary function assessment, 351 renal function assessment, 351 Liver surgery complications bleeding and excessive blood loss, 377–378 fluid management and transfusion, 379 pharmacologic agents, 380 small-for-size syndrome, 382 surgical technique, 378–379 minimal invasive resection, 384 perioperative hepatic insufficiency, 380 ischemia reperfusion injury, 380 treatment, 381–382 Liver transplantation, 82–83, 93–94, 448, 456, 485, 486 abdominal incision and exposure, 124–126 535 AKI after (see Acute kidney injury (AKI)) anesthesia and perioperative care, 95–96 anesthetic considerations, 259 anhepatic phase, 129 arterial reconstruction, 125 back table preparation, 124 between 1991 and 2009, 102 biliary complications, 428 cadaveric liver grafts, 104 cardiovascular changes cardiac output, 165 extrinsic factors, 164 hemodynamic changes, 164 inotropes and vasopressors, 165–166 intrinsic factors, 163–164 pathogenic mechanisms, 164–165 phases, 167 physiological considerations, 163 cardiovascular response, 415 caval anastomosis, 128 caval replacement vs piggyback, 94–95 cerebrovascular stability, 259–261 coagulation response, 420 coagulopathy, 261–262 consequence of CAD, 284 contraindications to, 57 early modern era, 89 early postoperative care, 96 end to side, 129 fast-tracking, 96–97 glycemic control, 419, 427 graft function evaluation, 427–428 hemodynamic changes during anhepatic phase, 167–168 during dissection phase, 167 during graft reperfusion, 168 during the neo-hepatic phase, 169 hemodynamic disturbance, 166–167 hemodynamic monitoring, 420–421 hemostatic alterations in, 195 hepatic artery anastomosis, 125 hepatic encephalopathy, 426 history of, 121–123 hypotension, 416 ICU complication prevention, 428 immunosuppression, 424 immunosuppressive agents, 90–91 indications for, 32, 111 interventions anhepatic phase, 168 dissection phase, 167 graft reperfusion, 168–169 neo-hepatic phase, 169–170 intraoperative management of renal function, 275–276 living donor (see Living donor liver transplantation (LDLT)) management of coagulopathy and bleeding, 427 mechanical ventilation, 421, 470 metabolic abnormalities during, 248 Index 536 Liver transplantation (cont.) native liver hepatectomy, 125–127 neurological outcomes after, 325 neurological response, 418 organ preservation techniques and solutions, 91–92 organ response, 415–420 pediatric, 519 perioperative fluid balance, 262–264 portal vein thrombus, 126 postoperative care, 416 pre-procurement biopsy, 118 in presence of newly transplanted heart, 239–240 in presence of renal failure, 236 procedure, 123 pulmonary response, 417 renal replacement therapy, 276 renal response, 418 rejection, 432 sedation and analgesia, 422, 425 sodium and electrolyte management, 419, 426 super-urgent listing for, 55 surgical considerations, 259 survival of patients, 58 technical and conceptual foundations, 89–90 technical innovations, 97 temporary portocaval, 123 vascular complications, 428 worldwide growth, regulation and academic organizations, 98 Liver tumor, 226, 338 Liver volumes, 57 Liver–kidney transplantation, 249 Living donation (LD), 105–106 Living donor hepatectomy, 367–370, 516–519 altruistic nature of, 373 anesthetic management, 371–372 clinical and biological outcome of, 373 complications, 373–374 evaluation criteria, 369 post-operative management, 372 preoperative evaluation, 367 contraindications to donations, 370 ethical considerations, 369–370 first evaluation phase, 367–368 second evaluation phase, 368 third evaluation phase, 368–369 surgical technique, 370–371 Living donor liver transplantation (LDLT), 97, 105, 118, 252 epidemiology, 485–486 ethical issues, 487 mortality rates, 492–494 postoperative care, 488 postoperative complications, 491–492 analgesia, 490–491 antibiotic prophylaxis, 489 bile leak, 492 Clavien’s classification system, 491, 492 DVT, 488 hemorrhage, 492 infection, 492 IV fluids and nutrition, 490 laboratory testing, 490 liver failure post-donation, 493 long-term follow up, 491 pulmonary embolism, 493 PVT, 493 radiological evaluation, 490 risk factors, 488 surgical technique, 486–488 Local infiltration, 514 Lorazepam, 424 L-Ornithine-L-aspartate (LOLA), 317 Low molecular weight (LMWH), 489 Low serum sodium, 137 Lung Allocation Score (LAS), 240 Lymphocyte, M Macrosteatosis, 117 Maddrey discriminant function (MDF), 23 Magnetic resonance imaging (MRI), 138, 493 Major histocompatibility complex (MHC), 433 Major histocompatibility complex I (MHC I) markers, 11 Malignant liver lesions, 342–343 Malnutrition, 351 Mammalian target of rapamycin (mTOR) inhibitors, 438 adverse effect, 439 clinical use, 439 method of action, 439 pharmacokinetics and metabolism, 439 therapeutic drug monitoring, 439 Mannitol, 166, 318 Marginal donors and ABO incompatibility, 264–265 Mass spectrometry, 509 Matrix metalloproteinase (MMP-9), 308 Mayo Clinic, 391 MDR Pseudomonas, 461 Mean pulmonary artery pressure (MPAP), 400 Mechanical ventilation liver transplantation, 421–422 non-invasive, 472, 473 prolonged, 472 sedation during, 473 weaning protocol, 470, 473 Mechanical ventilators, 92 Metabolic acidosis, 426 Metabolic alkalemia, 427 Metabolic alkalosis, 403 Metabolic syndrome, 15 Metabolism, 508 buprenorphine, 510 dexmedetomidine, 511 fentanyl, 510 gabapentin, 512 hydromorphone, 509 methadone, 509 morphine, 508 Methadone, 509 Index Methadone maintenance therapy (MMT), 509, 513 Methicillin-resistant Staphylococcus aureus (MRSA), 456, 458–459 Methylene blue test, bile leak, 504 Micafungin, 463, 464 Microbubble, 301 Microdialysis, 136, 137 Microwave ablation (MWA), 113 Midazolam, 75 Middle hepatic vein (MHV), 333 Minimal invasive resection, 384 Minimally invasive hepatic surgery, 338 MMF, see Mycophenolate mofetil (MMF) Mobile army surgical hospital (MASH) system, 93 Model for end stage liver disease (MELD) score, 57, 82, 97, 101, 294, 308, 380, 392, 393, 441, 452, 470–472, 498 advantages of, 102 coagulopathy and transfusion, 250–251 disadvantage, 102 disease severity, 112 formulas for, 112 futility, 254 implementation, 247–248 organ allocation, 252–253 on post-transplant survival, 102 predictive accuracy, 137 renal insufficiency, 248–250 severity of disease, 251–252 Share 35, 253–254 short term prognosis of patients, 112 temperature, 137 at transplantation, 113 Modified Ramsay Sedation Scale, 423 MOF, see Multiorgan failure (MOF) Molecular adsorbent recirculating system (MARS), 275, 317, 501 Monoclonal antibodies, 440 Monoclonal antibody therapy, 476 Monoethylglycinexylidide (MEGX) test, 80, 83–84 Morphine, 77, 508–509 Morphine-3-glucuronide (M3G), 508 Morphine-6-glucuronide (M6G), 508 MPAG, see Mycophenolic acid glucuronide (MPAG) MRSA, see Methicillin-resistant Staphylococcus aureus (MRSA) mTOR inhibitors, see Mammalian target of rapamycin (mTOR) inhibitors Multiorgan failure (MOF), 257 Multiorgan system failure, 452 Multiply resistant gram-positive/negative bacteria amphotericin B, 463 CRAB, 462 CRKP, 461 echinocandin, 463 ESBL producing enterobacteriaceaes, 460 invasive aspergillosis, 464 MDR Pseudomonas, 461 MRSA, 458, 459 triazoles, 463 537 VRE, 459, 460 Muscle relaxants, 92 Mycophenolate mofetil (MMF), 265, 437 adverse effect, 438 clinical use, 438 method of action, 438 pharmacokinetics and metabolism, 438 therapeutic drug monitoring, 438 Mycophenolic acid glucuronide (MPAG), 438 Myectomy, 289 Myeloproliferative disorders, 46 Myocardial perfusion scan, 286 Myofibroblasts, 26 N N-acetylcysteine (NAC), 13, 44, 166 N-acetyl-p-benzoquinone-imine (NAPQI), 13 NAFLD, see Nonalcoholic fatty liver disease (NAFLD) National Institute on Alcohol Abuse and Alcoholism, 403 National Institutes of Health, 476 National Institutes of Health (NIH) Consensus Conference on Liver Transplantation, 94 Native liver hepatectomy, 125 Natural killer (NK) cells, 10, 11, 358 Natural killer T (NKT) cells, 11 Near infrared spectrophotometry (NIRS), 313 Near-infrared spectroscopy (NIRS), 138 Neoangiogenesis, Neonatal hypoxia, 226 Neonatal liver failures, 226 Nephropathy, 418 Nephrotoxicity, 458, 463 Neuraxial anesthesia, 516, 517, 519 Neurologic dysfunction, liver disease, 403 Neurologic system, caval cross-clamping, 157 Neurological monitoring, 138 Neuromuscular blockade, 316 Neuromuscular blocking agents, 76, 405 Neurotoxic ammonia, 136 Neurotoxicity, 436 Neutrophil function, 53 Neutrophil gelatinase-associated lipocalin (NGAL), 273, 446 NHS Blood and Transplant, 102 Nitric oxide (NO), 164 Non-absorbable disaccharides, 426 Non-alcoholic fatty liver disease (NAFLD), 15, 22, 23, 396 Non-alcoholic steatohepatitis (NASH), 23, 284, 396 Non-anatomic resections, 334 Noncardiogenic pulmonary edema, 418 Non-cirrhotic liver disease, 394 Non-dihydropyridine calcium channel blockers, 417 Non-invasive ventilation (NIV), 472–474 Nonparenchymal cells, Non-selective cyclo-oxygenase inhibitor, 320 Norepinephrine, 29, 276 538 Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR), 427 Normothermia, 314 Normothermic MP (NMP), 215 Nosocomail pneumonia, 458 Nutrition, LDLT, 490 O Off-pump coronary artery bypass (OPCAB), 284, 288–289, 396 OKT3 (muromonab-CD3), 440 Oliguria, 501 OPCAB, see Off-pump coronary artery bypass (OPCAB) Open cholecystectomy, 396 Open laparotomy, liver disease, 395 Operating room, patients, 258 Opioids, 77, 424, 508 equipotent doses, 511 liver disease, 406 use of, 513 Oral tolerance, 12 Organ allocation, 97 MELD score, 252 pediatric liver transplantation, 221 Organ distribution, 102–103 Organ donation, 94, 97–98 Organ preservation, 91, 124, 212 Organ Procurement and Transplant Network (OPTN) data, 234, 253 Organ procurement organizations (OPOs), 102, 113, 114 Organ Procurement Transplantation Network (OPTN), 113, 114, 221 Organomegaly, 295 Orthodeoxia, 300, 301 Orthotopic liver transplantation, 121 Osler–Weber–Rendu disease, 298 Osmolar damage, 104 Osmotherapy, 318 Osmotic demyelinisation, 137 Osmotic myelinolysis, 318 Oximetry, jugular bulb, 312 P Packed red blood cells (PRBC), 379 Pain management, 514 acute, 508, 515 buprenorphine, 510 chronic, 515, 519 dexmedetomidine, 511 fentanyl, 510 gabapentin, 512 hydromorphone, 509 intraoperative analgesia, 513–514 living donor hepatectomy, 516 local infiltration, 514 methadone, 509 morphine, 508 Index multimodal approaches to, 514 pediatric, 519 perioperative, 512–513 post-operative analgesia (see Post-operative analgesia) Pancuronium, 76 Paracentesis, 397 Paracetamol overdose (POD), 43–44 Paracetamol-induced liver injury, 257 Parenchymal disease, 299 Parenteral nutrition (PN), 501 Partial thromboplastin time (PTT), 15 PD, see Pharmacodynamics (PD) Pediatric end-stage liver disease model (PELD), 112, 221, 222 Pediatric liver transplantation, 227–229, 519 age distribution, 222–223 anesthetic management infants and toddlers, 227–229 pre-teenager, 229 teenager, 229 biliary atresia, 224–225 biliary complications, 230 cholestatic liver disease, 223–224 congenital heart disease, 227 fulminant hepatic failure, 226 hepatic encephalopathy, 227 history of, 221 indication for, 223 infectious complications, 231 liver tumors, 226 metabolic disease, 222, 225–226 neonatal liver failures, 226 organ allocation, 221–222 outcome, 231 post operative care, 229–230 primary nonfunction, 231 rejection, 230 SPLIT database, 231 TPN-induced liver disease, 227 vascular anomalies, 227 vascular complications, 230 Pentoxifylline, 382 Percutaneous transluminal coronary angioplasty (PCTA), 284 Perioperative complication, liver disease, 391 Peritoneal dialysis, 274 Perpetuation, 26 Pharmacodynamics (PD), 71–72 absorption, 71 changes in patients, 74 elimination, 72 hepatic dysfunction, 70 metabolism, 72 neuromuscular blocking agents, 76 opioids, 77 protein binding and distribution, 72 sedatives, 75 Pharmacokinetics (PK), 69–71 absorption, 71 Index classifications, 70 of drugs, 352 elimination, 72–74 hepatic dysfunction, 70 metabolism, 72 neuromuscular blocking agents, 76 opioids, 77 protein binding and distribution, 72 sedatives, 75–76 Pharmacological agents, 199, 380 Pharmacovigilance Risk Assessment Committee (PRAC), 358 Phase I oxidative pathways, 79 Piggyback technique, 94, 122, 123, 128, 259 advantages of, 158 of orthotopic liver transplantation, 157–159 placement, 158 Piperidine opioids, 77 PK, see Pharmacokinetics (PK) Plasma exchange, 318 Plasmapheresis, 449 Plasminogen activator inhibitor-1 (PAI-1), 179 Platelet function, in liver disease, 179 Platelet function analyzer-100 (PFA-100), 180 Platelet transfusion, 184 Platelets, 379 Platypnea, 400 Pleural space disease, 298 Pneumonitis, aspiration, 476 POD, see Paracetamol overdose (POD) Polyclonal antibodies, 439 POPH, see Portopulmonary hypertension (POPH) Portal hypertension, 26, 27, 294, 390, 392, 395 Portal pressure, 64 Portal vein anastomosis, 128 Portal vein embolization (PVE), 345, 383, 499 Portal vein flow (PVF), 383 Portal vein thrombosis (PVT), 30, 131, 428, 493 Portal venous blood flow (PBF), 163 Portocaval shunt (PCS), 384 Portopulmonary hypertension (PPH), 29, 150, 239, 298, 400, 475 Portosystemic encephalopathy (PSE), 28 Posaconazole, 463, 464 Positive end expiratory pressure (PEEP), 50, 314, 421, 476, 477 Post hepatectomy liver failure, 344–347 Post live transplantation, immunosuppression approach, 440 Post operative care, pediatric liver transplantation, 229 Posthepatectomy liver failure, risk factors, 493 Post-operative analgesia, 514 behavioral approaches, 515 invasive pain interventions, 516 pharmacotherapeutics, 514 physical modalities, 515 Postoperative care LDLT, 488 liver transplantation, 416 Postoperative complications, 488 539 cirrhosis, 390 LDLT (see Living donor liver transplantation (LDLT)) liver disease, 407 Postoperative liver dysfunction (POLD), 405 Post-renal kidney injury, 271 Postreperfusion syndrome, 417 Post-transplant lymphoproliferative disorder (PTLD), 440, 449 PPH, see Portopulmonary hypertension (PPH) PPV, see Pulse pressure variation (PPV) Pregablin, 514 Pre-renal kidney injury, 271 Pre-teenager, anesthetic management, 229 Primary biliary cirrhosis, 297 Primary nonfunction (PNF), 209 Primary sclerosing cholangitis (PSC), 130, 343 Pringle’s maneuver, 337, 352, 353, 500 Procalcitonin (PCT), 456 Procoagulant drugs, 185 Prolonged cold ischemic time, 209 Prolonged hypothermia, 321 Prolonged mechanical ventilation, 470–472 Prophylactic anticoagulation, 399 Prophylactic hyperventilation, 314 Prophylaxis deep vein thrombosis, 488 disadvantage, 458 role of, 457–458 (see also specific prophylaxis) Propofol, 75, 316, 406, 424 Propofol infusion syndrome (PRIS), 424 Protein binding capacity, 73 and distribution, 72 Protein C, 177 Protein metabolism, 14 Proteins induced by Vitamin K absence (PIVKA), 398 Prothrombin complex concentrates (PCCs), 200, 261, 399 Prothrombin time (PT), 15, 56, 180, 195, 398, 399, 452, 453 PSC, see Primary sclerosing cholangitis (PSC) PSE, see Portosystemic encephalopathy (PSE) Pulmonary artery catheter (PAC), 139, 149, 165, 236, 355–356, 421, 475 Pulmonary artery occlusion pressure (PAOP), 150 Pulmonary artery pressures, 150, 475 Pulmonary disease, 399 hepatic hydrothorax, 400 HPS, 400 portopulmonary hypertension, 400 Pulmonary edema, 474 Pulmonary embolism, LDLT, 493 Pulmonary function assessment, 351 in patients with cirrhosis, 294–295 Pulmonary function test, 294, 301 Pulmonary hypertension (POPH), 299–300 Pulmonary response, liver transplantation, 417 Pulmonary system, caval cross-clamping, 156 540 Pulmonary vascular resistance (PVR), 400 Pulmonary vasodilator therapy, 400 Pulse contour cardiac output (PiCCO™), 165 Pulse oximetry, 139 Pulse pressure variation (PPV), 140, 354, 355 PVE, see Portal vein embolization (PVE) PVT, see Portal vein thrombosis (PVT) Pyrogenic abscess, 340 Q Quantitative liver function test, 79 Quinopristin-dalfopristin, MRSA, 458–459 R RAAS, see Renin angiotensin aldosterone system (RAAS) Radio frequency ablation (RFA), 113 Radiology, LDLT, 490 Raft function monitoring, 140 Randomized clinical trials (RCT), 200 Randomized Evaluation of Normal versus Augmented Level (RENAL) study, 56 Rapamycin, 447 RASS, see Richmond Agitation-Sedation Scale (RASS) Reactive oxygen species (ROS), 213 Rebalanced hemostasis, 398 Recipient prioritizing, 101–102 Recombinant Factor VIIa (rFVIIa), 186–187, 262, 380 Recovery from hyperfibrinolysis, 262 liver transplantation, 265 Rectus abdominis (RA), 517–519 Red cell transfusion, 358 Refractory vasoplegia, 273 Regional anesthesia, 404 Rejection allograft mechanisms, 433, 434 features, 433 immunological, 431 liver transplantation, 432 treatment of, 476 Remifentanil, 77, 352, 406 Renal allograft dysfunction, 237 Renal dysfunction, 441 Renal failure, 270 Renal function assessment, 351 evaluation, 401 intraoperative management of, 275 Renal injury, see Acute kidney injury (AKI) Renal insufficiency, 248, 270 Renal replacement therapy (RRT), 50, 156, 248, 274, 276–278, 445, 448, 449 Renal system, caval cross-clamping, 156 Renal transplantation, in presence of newly transplanted liver, 237 Renin angiotensin aldosterone system (RAAS), 282, 283 Renin angiotensin system (RAS), 53 Index Reno-portal anastomosis (RPA), 131 Reperfusion, 128 Reperfusion injury, 213 Respiratory failure, 296 Restrictive lung disease, 294 rFVIIa, Recombinant Factor VIIa (rFVIIa) Richmond Agitation-Sedation Scale (RASS), 422, 423 Rifaximin, 28 Right heart failure, Right ventricular systolic pressure (RSVP), 299 Risk, injury, failure, loss, end-stage (RIFLE) criteria, 235, 270, 272, 446 Rocuronium, 76 Rotational thromboelastometry (ROTEM®), 251, 261, 489 Roux-en-Y hepatico-jejuonostomy, 131, 344 Roux-en-Y jejunal limb, 131 RRT, see Renal replacement therapy (RRT) S Salvage therapy, 464 Sarcopenia, 351 SBP, see Spontaneous bacterial peritonitis (SBP) Scandiatransplant, 102 Scientific Registry of Transplant Recipients (SRTR) database, 98, 210, 237, 253 Scintigraphy, liver, 499 Second International Consensus Conference on Laparoscopic Liver Resections, 487 Sedation and analgesia, 422–425 during mechanical ventilation, 473 scales, 423 Sedative agent, 316 Segmental biliary dilation, 340 Selective bowl decontamination, 457 Selective digestive tract decontamination (SDD), 457 Sepsis pathophysiology, 502 pseudomonas, 461 Seronegative ALF, 46 Seropositive donors, 209 Serum albumin, 112 Serum creatinine (SCr), 112, 401 Serum cystatin C, 273 Serum sodium, 112 Serum-ascites albumin gradient (SAAG), 27 SFSS, see Small-for-size syndrome (SFSS) Share-35 rule, 114, 115, 253 Sickest first model, 97 Simultaneous liver–kidney transplantation (SLKT), 233–235 eligibility criteria for, 235 intra-operative management, 236 post-operative management, 237 pre-operative evaluation, 235–236 Single pass albumin dialysis (SPAD), 275 Single photon emission computed tomography (SPECT), 286 Index Sinusoidal constriction, 64 Sinusoidal endothelial cells (SECs), 212 Sirolimus, 438 adverse effect, 439 clinical use, 439 method of action, 439 pharmacokinetics and metabolism, 439 therapeutic drug monitoring, 436, 439 Skin- and soft tissue infections (SSTI), 458 SLKT, see Simultaneous liver–kidney transplantation (SLKT) Small-for-size syndrome (SFSS), 382–384, 453 Smoking, 488 Society of Critical Care Medicine, 473 Sodium bicarbonate, 276 Sodium management, liver transplantation, 419, 426 Sodium-MELD score, 112 Solid organ transplantation, 491 Solute carrier (SLC) transporters, 13 Spanish Model of Organ Donation, 103 Spanish transplant system, 103 Spironolactone therapy, 397 Splanchnic vasodilation, 26 Splanchnic venous pressure, 198 Splenectomy, 383 Splenic artery ligation (SAL), 383 Split liver transplant (SLT), 211–212 Spontaneous bacterial peritonitis (SBP), 27 Spontaneous breathing trials (SBTs), 472, 473 Squibb Institute for Medical Research, 463 Standard cold storage (SCS), 214 Standard criteria donor (SCD), 211 Standard exception (SE), 101 Standard hemodynamic monitoring, 139 Static liver function test, 80 Statins, 350 Steatosis, 117, 209 Stellate cells, 8, Stroke volume index, 150 Stroke volume variation, 140 Studies of Pediatric Liver Transplantation (SPLIT), 222 Subdural devices, 138 Succinylcholine, effects, 405 Summagadex, 76 Supportive care, 493 Sustained low efficiency dialysis (SLED), 276 SVR, see Systemic vascular resistance (SVR) Sympathetic nervous system (SNS), 282, 283 Sympatho-adrenal system, 275 Synthetic dysfunction, 26 Systemic inflammation, cerebral blood flow and, 309 Systemic inflammatory process, 50 Systemic vascular resistance (SVR), 155, 281–283 Systolic anterior motion (SAM), 289 T Tacrolimus, 435 adverse effects, 436 clinical use, 436 541 method of action, 435 pharmacokinetics and metabolism, 435 therapeutic drug monitoring, 436 Target-controlled propofol infusion, 352 T-cell activation, 433–434 99m Tc-mebrofenin scintigraphy, 499 TEE, see Transoesophageal echocardiography (TEE) Teenager, anesthetic management, 229 Temporary portocaval shunt (TPCS), 122, 123, 127 Terlipressin, 29, 165 Thalium-persantine angioscintigraphy, 350 Therapeutic hypothermia (TH), 320–321 Thiopurine methyltransferase (TPMT), 437 Thoracentesis, preoperative/postoperative, 400 Thoracic surgery, liver disease, 397 Three-dimensional computed tomography (3D–CT), liver, 487, 493 Thrombectomy, blood loss during, 127 Thrombin activatable fibrinolysis inhibitor (TAFI), 16, 178, 179 Thrombin generation test, 181 Thrombocytopenia, 398, 427 Thromboelastography (TEG), 181, 182, 199, 251, 261, 263, 489 Thromboembolic prophylaxis, 428 Thrombopoietin, 16 Thrombotic thrombocytopenic purpura (TTP), 448–449 Tigecycline MRSA, 458–459 VRE, 459 Tissue factor (TF), 175 Tissue factor pathway inhibitor (TFPI), 176 Tissue Factor VIIa, 380 Tissue plasminogen activator (tPA), 16, 177, 179, 197, 399 T lymphocytes, 10 Toddlers, anesthetic management, 227 Toll-like receptor (TLR 4), 12 Topical hemostatic agent, 380 Toronto Live Donor Liver Transplant Program and certain Asian programs, 486 Total intravenous anesthesia (TIVA), 353 Total parenteral nutrition (TPN), 52, 227 Total vascular isolation (TVI), 336, 341 Toxic liver syndrome, 259 Tracheal extubation, 421 Tracheostomy, 473 TRALI, see Transfusion related lung injury (TRALI) Tranexamic acid (TxA), 186 Tranexanic acid, 359 Trans arterial chemoembolization (TACE), 113 Transcapillary filtration pressure, 276 Transcatheter aortic valve implantation (TAVI), 288 Transcatheter aortic valve replacement (TAVR), liver disease, 397 Transcranial Doppler sonography, 138 Transcranial Doppler ultrasound (TCD), 312 Transcutaneous electrical nerve stimulation (TENS) therapy, 515 Index 542 U U.S. Nationwide Inpatient Sample (NIS), 397 UDP-glucuronyl transferase 1, 79 Ulinastatin, 382 Ultrasonography (US), 339, 341 Unfractionated heparin, 489 United Network for Organ Sharing (UNOS), 113 Uridine diphosphate-glucuronosyltransferases (UGTs), 508 US Preventive Services Task Force (USPS), 24 Vaptans, 426 Vascular anomalies, 227 Vascular complications assessment, 428 LDLT, 493 pediatric liver transplantation, 230 Vascular occlusion hemodynamic consequences of, 352 types, 337 Vasoconstrictor, 274 Vasodilatation, 271 Vasodilation, 417 Vasodilator, 286 Vasodilatory effect, 282 Vasogenic edema, 15 Vaso-mediated pulmonary hypertension, 239 Vasopressin, 65, 165 Vasopressors, 165, 166, 252, 276 Vasosol, 214 Vecuronium, 76 Vena Cava management, 122 Vena porta, 127 Veno-occlusive disorders, 46 Venous thromboembolism, 428 Veno-venous bypass (VVB), 122, 159, 160, 259, 322 Ventilator associated pneumonia (VAP), 470, 474–475 Ventilator bundles, 473 Ventral endoderm, Viral hepatitis, 44–45 Visceral circulation, Viscoelastic assays, 493 Visco-elastic coagulation testing, 261 Viscoelastic testing, 150–151, 201 Vitamin K-dependent coagulation factors, 398 Volatile anesthesics, 352, 382, 405 Von Willebrand factor (VWF), 15, 174 Voriconazol, aspergillosis, 464 VRE, see Vancomycin-resistant enterococci (VRE) V Valvular disease, 288 Vancomycin, 458 Vancomycin-resistant enterococci (VRE), 459, 460 VAP, see Ventilator associated pneumonia (VAP) W Water-soluble drugs, 72 Weaning, from mechanical ventilation, 470 Wernicke’s encephalopathy, 404 Wilson’s disease (WD), 47, 225, 325–326, 404 Transesophageal echocardiography (TEE), 140, 141, 150, 165, 356, 407, 421 Transfusion, 358 Transfusion associated circulatory overload (TACO), 183, 202, 399 Transfusion related acute lung injury (TRALI), 183, 202, 427, 474, 475 Transjugular intrahepatic portosystemic shunt (TIPS), 98, 112, 275, 282, 345, 392, 393, 395, 397, 400 Transmitral flow, 283 Transoesophageal echocardiography (TEE), 356–357 Transplantable organs, amount of, 115 Transpulmonary thermodilution cardiac output monitors, 50 Transthoracic echocardiography, 407 Transverse abdominis plane (TAP), 372, 516 Triazoles, 463 Tricyclic antidepressants (TCAs), 519 Trisegmentectomy, 334 Tris-hydroxymethyl aminomethane (THAM), 276 Trojan horse hypothesis, 14 TTP, see Thrombotic thrombocytopenic purpura (TTP) T-tube drain, 130 Tumor-associated antigens (TAA), 12 Tympanic tonometry, 313 .. .Liver Anesthesiology and Critical Care Medicine Gebhard Wagener Editor Liver Anesthesiology and Critical Care Medicine Second Edition Editor Gebhard Wagener Department of Anesthesiology, ... anesthetic and critical care management of these patients Liver anesthesiology and critical care medicine has matured into a subspecialty in its own right with national and international societies and. .. was published six years ago Since then liver anesthesiology and critical care medicine has rapidly evolved in pace with new developments in surgery and transplantation Laparoscopic and laparoscopic-assisted