Anesthesia for Hepatico-Pancreatic-Biliary Surgery and Transplantation 3030513300, 9783030513306

Table of contents :
Contents
Part I Anatomy and Physiology of the Liver
Chapter 1 Anatomy of Hepato-Pancreato-Biliary Surgery and Liver Transplantation
Introduction
Arteries
Veins
Anatomical Variations
Arteries
Veins
Portosystemic Shunts
Liver
Biliary Tree
Pancreas
References
Chapter 2 Anatomy and Physiology of the Liver
Introduction
Macroscopic Anatomy
Structural Anatomy
Functional Anatomy
Blood Supply to the Liver
Portal Vein
Hepatic Artery
Vascular Segments
Drainage from the Liver
Venous Drainage
Bile Drainage
Lymphatic Drainage
Nerve Supply of the Liver
Microscopic Anatomy
Liver Lobules
Liver Acinus
Cells Within the Liver
Hepatocytes
Sinusoidal Cells
Liver Function
Nutritional Modulation by the Liver
Metabolism of Carbohydrates
Lactate Metabolism
Protein Synthesis and Metabolism
Inflammatory Proteins and Protease Inhibitors
Synthesis and Regulation of Coagulation Factors
Amino Acid Metabolism and Nitrogen Balance
Lipid Metabolism
Ketone Body Production
Synthesis of Bile
Metabolism and Clearance of Drugs
Phase 1
Oxidation Reactions
Reduction
Hydrolysis
Phase 2
Hepatic Clearance of Drugs
Age and Nutritional Status
Storage and Homeostasis of Iron
Storage and Regulation of Vitamins
Vitamin D Metabolism
Regulation of Hormones
Summary
References
Part II Liver Transplantation
Chapter 3 Pathophysiology Behind Cardiopulmonary Complications of Cirrhosis and Portal Hypertension
Abbreviations
Introduction
Pathophysiology of Haemodynamic Alterations in Cirrhosis
Abnormal Haemodynamic Homeostasis
Cardiovascular Complications of Cirrhosis
Hyperdynamic Circulation
Cirrhotic Cardiomyopathy
Pathophysiology
The Cirrhotic Heart
Coronary Artery Disease
Definition of Cirrhotic Cardiomyopathy (CCM)
Systolic Dysfunction
Diastolic Dysfunction
Prolonged QT Interval
Treatment and Evaluation of Cardiac Function in Liver Disease
Respiratory Complications in Patients with Liver Disease
Hepatopulmonary Syndrome
Pathophysiology of the Hepatopulmonary Syndrome
Diagnosis of the Hepatopulmonary Syndrome
Prognosis
Intrapulmonary Vascular Dilatation
Treatment of Hepatopulmonary Syndrome
Porto-Pulmonary Hypertension
Clinical Signs and Diagnosis
Pathophysiology of Porto-Pulmonary Hypertension
Treatment of Portopulmonary Hypertension
Hepatic Hydrothorax
Conclusive Remarks
References
Chapter 4 Liver Transplantation: Graft Variables
Graft Types
Donor After Brain Stem Death (DBD)
Donor After Cardiac Death (DCD)
Partial Liver Grafts (Reduced, Split and Living Related)
Auxiliary Partial Liver Transplantation (APOLT)
Domino
Ischemic Times of Note
Cold Ischemic Time
Warm Ischemic Time (WIT)
The Marginal Graft
Donor Recipient Matching
Liver Preservation
Cold Static Storage (CSS)
Machine Perfusion: Normothermic/Hypothermic
References
Chapter 5 Surgical Aspects of Liver Transplantation
Introduction
Basic Liver Pathophysiology and Haemodynamics
Cadaveric Liver Graft Anatomy
Liver Tranplantation
Temporary Porto-Caval Shunt (TPCS)
Piggyback Liver Transplantion–Types of Outflow Anastomosis
Technical Considerations
Post-transplant Complications
Vascular Complications
References
Chapter 6 Pre-assessment for Hepato-Pancreato-Biliary and Liver Transplant Surgery
Preoperative Assessment of Liver Transplant Candidates
Assessment of the Severity of ESLD
Child-Turcotte-Pugh (CTP) Classification
Model for End-Stage Liver Disease (MELD) Score
Modifications of the MELD Score
Future Improvements in Severity Scoring
Neurological Disorders of ESLD
Hepatic Encephalopathy
Cerebral Edema
Cardiovascular Diseases in ESLD
Hyperdynamic Circulation and Cirrhotic Cardiomyopathy
Coronary Artery Disease
Heart Failure
Valvular Diseases
Infiltrative Cardiomyopathies
Atrial Fibrillation
Comprehensive Assessment of Cardiovascular Risk in Liver Transplant Candidates
Pulmonary Disorders of ESLD
Hepatopulmonary Syndrome
Portopulmonary Hypertension
Gastrointestinal Disorders of ESLD
Gastrointestinal Hemorrhage
Ascites
Renal Disorders of ESLD
Hepatorenal Syndrome (HRS)
Acute Kidney Injury (AKI)
Coagulation Disorders of ESLD
Pathophysiology
Diagnostic Laboratory Tests
Metabolic Disorders of ESLD
Obesity
Non-alcoholic Fatty Liver Disease (NAFLD)
Malnutrition, Sarcopenia and Frailty in ESLD
Malnutrition
Sarcopenia
Frailty
Substance Abuse in ESLD
Alcohol Abuse
Tobacco Abuse
Illicit Drug Abuse
Preoperative Assessment of Patients for Non-transplant, Hepatico-Pancreatic-Biliary Surgery
Assessment of Cardiovascular Status
Assessment of Liver Function
References
Chapter 7 The Role of Cardiopulmonary Exercise Testing (CPET) in the Preoperative Assessment of Patients for Hepatico-Pancreatic-Biliary (HPB) Surgery and Liver Transplantation (LT)
Introduction
The Physiology of Exercise
Conducting the Cardiopulmonary Exercise Test
Nine Panel Plot and Interpretation
Evidence Base for Risk Prediction of Mortality and Morbidity
Pre-operative Optimisation
Post-operative Resource Allocation
Interpreting CPET in Patients with Liver Failure Awaiting LT
Interpreting CPET in HPB Patients
Practical Use of CPET at King’s College Hospital
Summary
References
Chapter 8 Anaesthesia for Liver Transplantation
Introduction
Anaesthetic Management
Induction and Maintenance of Anaesthesia
Intraoperative Fluids Administration Management
Phases of LT
Neo-Hepatic Phase
References
Chapter 9 How Does the Aetiology of Primary Liver Disease Affect Anaesthesia for Liver Transplantation
Introduction
Acute Liver Failure
Clinical Picture of ALF
Treatment of ALF
Complications
Recommendations for Anaesthesia in Patients with Acute Liver Disease
Viral Hepatitis
Alcohol Related Liver Disease
Multi-organ Failure in Alcohol Related Liver Disease
Non-alcoholic Fatty Liver Disease
Autoimmune Hepatitis
Cholestatic Disorders
ɑ1-Antitrysin Deficiency
Wilson’s Disease
Haemochromatosis
Vascular Conditions
Polycystic Liver Disease
Cystic Fibrosis
Pregnancy-Related Liver Disease
References
Chapter 10 Haemodynamic Monitoring During Liver Transplant Surgery
Introduction
Invasive Blood Pressure (IBP) Measurement
Central Venous Pressure
Pulmonary Artery Catheter (PAC)
Transoesophageal Echocardiography
Assessment of Ventricular Function
Assessment of Volume
Pulse Contour Continuous Cardiac Output Devices
PiCCO System Monitoring During LT
Initial Transaortic (Transpulmonary) Thermodilution Bolus
LiDCO Haemodynamic Monitoring During LT
LiDCO Plus Ltd., Cambridge, UK
FloTrac/Vigileo Haemodynamic Monitoring During LT
References
Chapter 11 Point of Care Viscoelastic Haemostasis Monitoring During Liver Transplant Surgery
Introduction
‘What Laboratory Tests Should We Use to Guide Coagulation and Transfusion Management During Liver Transplantation?’
Viscoelastic Tests
Thromboelastography
Thromboelastometry
‘How Do We Use POC Laboratory Tests to Support Coagulation and Transfusion Management During Liver Transplantation?’
‘Can POC Laboratory Testing Improve Patient Outcomes and Reduces Costs During LT?’
Conclusion
References
Chapter 12 How to Reduce Bleeding and Blood Transfusion During Liver Transplantation
How to Decrease Bleeding and the Need for Transfusion
Management of Coagulopathy
Monitoring
Transfusion Threshold
Physical Measures
Conclusion
References
Chapter 13 Fast Tracking in a Liver Transplant Programme
Introduction
History
Anesthesia for Fast Track
Implementing a Fast Track Program—The Mayo Clinic Florida Model
References
Chapter 14 Acute Kidney Injury in Hepatico-Pancreatic-Biliary Surgery and Liver Transplantation
Abbreviations
Introduction
Definitions
Biomarker for Early Detection and Guidance for Management
Risk Factors of Acute Kidney Injury After HPB Surgery
Risk Factors of AKI After Liver Transplantation
Recipient and Donor Characteristics
Surgical and Intraoperative Factors
Postoperative Factors
Strategies to Prevent AKI After HPB Surgery
Strategies to Prevent AKI After Liver Transplantation
Preoperative Preventions
Intraoperative Prevention and Management
Postoperative Management of Immunosuppressive Agent
Summary
References
Chapter 15 Use of Extracorporeal Membrane Oxygenation During Liver Transplantation
Introduction
Principles of ECMO
Circuit Configuration
Indications and Contraindications for ECMO in LT Patients
ECMO and Liver Transplant
Coagulopathy
Vascular Anastomosis
Conclusions
References
Chapter 16 Liver Preservation with Extracorporeal Perfusion
Abbreviations
Donor Liver Preservation Injury
Organ Preservation Modalities
Ex Situ Machine Perfusion
Normothermic Oxygenated Machine Perfusion
Hypothermic Oxygenated Machine Perfusion
In Situ Machine Perfusion
Conclusions
References
Chapter 17 Veno-Venous Bypass in Liver Transplantation
Introduction and Brief History
Principle of VVB in LT Surgery
Cannulation Technique
Haemodynamic Effects of IVC and Portal Vein Clamp, and Role of VVB
Effects of VVB on Renal Function
Reasons for the Gradual Decrease in the Use of VVB
Complications
Clinical Outcomes
Does the Surgical Approach Influence VVB Use?
Is Routine VVB Use Still Necessary?
References
Part III Liver Resection
Chapter 18 Biology of Liver Tumors and Outcomes of Liver Surgery
Introduction
Liver Malignancies
Primary Liver Tumors
Hepatocellular Carcinoma (HCC)
Cholangiocarcinoma (CCA)
Metastatic Liver Tumors
Colorectal Liver Metastases (CRLM)
Neuroendocrine Liver Metastases (NLMs)
Non-colorectal, Non-neuroendocrine Liver Metastases
References
Chapter 19 Anaesthesia for Live Donor Hepatectomy
Donation Criteria and Pre-assessment
Risk of Thromboembolism in Donors
Body Weight and Obesity
Evaluation of Graft and Remnant Donor Liver Volume
Anaesthetic Management
Intraoperative Monitoring
Other Alternatives to CVP Monitoring
Postoperative Pain Management
Intensive Care Unit Management for Donors
Donor Morbidity and Mortality
Laparoscopic Live Donor Hepatotomy
References
Chapter 20 Strategies for Low Central Venous Pressure in Liver Resection Surgery
Rationale for Low Central Venous Pressure Anaesthesia for Liver Resection
Strategies for Achieving Low CVP
Fluid Management
Pharmacological
Thoracic Epidural
Physical Manoeuvres
Surgical Strategies
Laparoscopic Liver Resection Surgery and Low CVP
Safety of Low CVP Anaesthesia in Liver Resection
Low CVP Anaesthesia Without CVP Monitoring?
Summary
References
Chapter 21 Enhanced Recovery After HPB Surgery
Introduction
Improvements in Perioperative Care
Liver Surgery
Pancreatic Surgery
ERAS
The ERAS Society (http://www.erassociety.org)
ERAS and Liver Surgery
ERAS and Pancreatic Surgery
Future Developments
Areas of Controversy
Conclusion
References
Chapter 22 Postoperative Analgesia in Liver Resection Surgery
Introduction
Basic Principles of Postoperative Analgesia
Simple Analgesics
Paracetamol
NSAIDs
Opioids
IV Lidocaine
Ketamine
Regional Anaesthesia
Safety
Coagulopathy
Epidural Anaesthesia
Intrathecal Opioids
Transversus Abdominis Plane Block and Quadratus Lumborum Blocks
Transversus Abdominis Plane Catheter
Erector Spinae Plane Blocks
Rectus Sheath Catheter
Wound Catheter
Conclusion
References
Part IV Pancreas
Chapter 23 Surgical Aspects of Hepato-Pancreato-Biliary Surgery
Introduction
Liver Surgery
Indications of Liver Surgery and Outcomes
Primary Liver Cancers
Cholangiocarcinoma (CCA)
Hepatocellular Carcinoma (HCC)
Metastatic Liver Disease
Gallbladder Cancer (GBC)
Types of Liver Resection
The Liver Resection
Extended Liver Resections
Post Hepatectomy Liver Failure (PHLF) and Small-for-Size Syndrome (SFSS)
Pancreatic Surgery
Pancreatic Surgery for Tumors Located in the Head of the Pancreas
Distal Pancreatectomy and Splenectomy
Total Pancreatectomy
Biliary Surgery
References
Chapter 24 Perioperative Anaesthetic Considerations for the Whipple Procedure and Other Pancreatic Surgeries
Pancreatic Surgery
Introduction
Anatomy and Physiology
Pancreatic Conditions Requiring Surgery
Neoplasms
Adenocarcinoma
Epidemiology
Clinical Features
Management
Intraductal Papillary Mucinous Neoplasm (IPMN)
Pancreatic Neuroendocrine Tumours (PNETS)
Epidemiology
Clinical Features
Management
Pancreatitis
Acute Pancreatitis
Chronic Pancreatitis
Emergency Surgery
Trauma
Surgical Techniques
Resections
Pancreaticoduodenectomy—The Whipple Procedure
Pylorus–Preserving Pancreaticoduodenectomy
Distal Pancreatectomy
Central Pancreatectomy
Total Pancreatectomy
Enucleation
Debridement
Lateral Pancreato-Jejunostomy (LPJ) and Frey Procedure
Laparoscopic Surgery
Perioperative Management
Preoperative
Assessment
Risk Scoring
Investigations
Cardiovascular Risk Assessment
Functional Capacity and Frailty
Optimisation
Enhanced Recovery After Surgery (ERAS)
Anaemia
Nutrition
Optimisation of Co-morbidities
Exercise Prehabilitation
Intraoperative Strategies
Analgesia
Goal Directed Fluid Therapy (GDT)
Ventilation
Prevention of Infection
Other Considerations
Specific Considerations for PNETs
Postoperative Strategies
Postoperative Complications
Pancreatic Fistula
Delayed Gastric Emptying
Haemorrhage
Exocrine Insufficiency
Management of Diabetes
Summary
References
Chapter 25 Anaesthetic Management for Patients Undergoing Pancreas Transplantation
Abbreviations
Introduction
Indications and Types of Pancreatic Transplantation
Indication of Patients for Pancreas and Kidney Transplantation
Preoperative Evaluation
Cardiac Testing for Pancreas with/without Kidney Transplantation
Evaluation of Other Systems
Pre-anaesthetic Management
Surgical Procedure
Pancreatic Graft Implant
Kidney Graft Implant
Anaesthesia and Intraoperative Management
Patient Position and General Care
Anaesthetic Agents
Invasive Lines
Haemodynamic Monitoring
Anaesthetic Management of Blood Sugars and Metabolic Abnormalities During Surgery
Metabolic Abnormalities
Fluids in Pancreas Transplant Surgery
Postoperative Care
Anaesthetic Management of Islet Transplantation (ITx) Patients
Complications and Outcomes of PTx
Complications Following ITx
Conclusions
References
Part V Paediatric
Chapter 26 Anaesthesia for Paediatric HPB Surgery
Introduction
Kasai Portoenterostomy for Biliary Atresia
Choledochal Cyst Resections and Other Hepatico-Entero Anastomosis Surgeries
Liver Tumour Resection
Anaesthesia for Complex HPB Procedures
Anaesthesia for Vascular Radiological Procedures
Anaesthesia for Vascular Surgical Procedures
Anaesthesia for Paediatric Pancreatic Surgery
Postoperative Analgesia for Paediatric HPB Surgery
References
Chapter 27 Anaesthesia for Paediatric Liver Transplantation
Background
General Indications for Transplantation
Contraindications
Preoperative Assessment for Liver Transplantation
Systemic Manifestations of End-Stage Liver Disease
Cardiovascular Function
Respiratory Function
Renal Function
Neurological Function
Haematological Function
Metabolic Function
Acute Liver Failure
Surgical Technique
Dissection Phase
Anhepatic Phase
Reperfusion Phase
Early Post-operative Phase
Anaesthetic Management
Pre-operative Assessment
Intraoperative Care
Post-operative Care
Graft Reduction and Split-Liver Transplantation
References
Chapter 28 Communication Between HPB Anaesthetists: Meetings, Websites and Forums
Anaesthesia and Critical Care Societies
Liver Intensive Care Group of Europe (LICAGE)
Liver Transplant Anaesthesia and Critical Care Forum (LiTAC)
Enhanced Recovery After Surgery Society (ERAS)
Enhanced Recovery After Surgery, United Kingdom (ERAS UK)
Evidence Based Perioperative Medicine (EBPOM)
Transplant Societies
International Liver Transplantation Society (ILTS)
British Transplant Society (BTS)
The Herrick Society
Solid Organ Transplant Pharmacy Association (SOTPA)
British Liver Transplant Group (BLTG)
European Society for Organ Transplantation (ESOT)
European Liver and Intestine Transplantation (ELITA)
The European Liver Transplant Registry (ELTR)
The Transplantation Society (TTS)
Surgical Societies
International Hepato-Pancreato-Biliary Association (IHPBA)
European-African Hepato-Pancreato-Biliary Association (EAHPBA)
Association of Upper Gastro- Intestinal Surgery of Great Britain and Ireland (AUGIS)
Medical Societies
British Association for the Study of the Liver (BASL)
European Association for the Study of the Liver (EASL)
Cancer Based Organisations
Pancreatic Cancer UK
Macmillan Cancer Support
References
Index

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