Brentjens T. Anesthetic considerations during liver surgery

Recent advances in surgical and anesthetic management have reduced the operative risk of major hepatectomies significantly. Although these advances have been multifactorial, anesthetic approaches derived from liver transplantation have had a major impact in our own practice and given us greater capacity to perform complex resections safely. We have been liberal in the use of vascular isolation techniques to prevent hemorrhage in our approach to liver surgery, a modification that mandates a high level of anesthetic expertise to manage complex liver cases [1]. Understanding the underlying pathological conditions of liver disease and the physiology of vascular exclusion and surgical resection has significantly contributed to goal-oriented anesthetic management. The recognition of the importance of expert anesthetic management for liver surgery has led to the formation of anesthesiology teams dedicated to liver surgery and trans-plantation in most major institutions. Preoperative considerations Surg Clin N Am 84 (2004) 401–411Our experience with hepatectomy over nearly 2 decades has spanned a broad range of clinical scenarios, ranging from the healthy living donor to the patient with advanced cirrhosis undergoing local excision of a malig-nancy. The preoperative assessment is tailored to accommodate the clinical * Corresponding author