Anesthetic Challenges for Major Hepatectomy

Abstract

Hepatic resection is the treatment of choice for many liver diseases. However, it is a large and complex operation with a high risk of side effects in the patients, and it is a challenge for both surgeons and anesthesiologists. This paper presents a case of successfully performed right hepatectomy in a 45-years-old woman with the finding of a giant liver hemangioma, larger than 10cm, placed near the inferior vena cava and the challenges faced by the anesthesiologists when guiding such a patient during the entire perioperative period. The main concern was the risk of massive blood loss, which might significantly increase the rate of morbidity and mortality. During liver resection, central venous pressure (CVP) was optimally maintained below 5cmH2O to reduce blood loss. The cell salvage technique was used to minimize heterologous blood transfusion. Epidural anesthesia can be safely applied in patients undergoing major hepatic resection, provided that they have corrected perioperative hemostasis. The surgical approach after Belghiti “liver hanging maneuver” performed by the surgeons in our case may involve transient compression of the inferior vena cava that cause profound hypotension. Therefore, a successful outcome requires close collaboration between the anesthesiology and surgical team by sharing decisions throughout the operation and following and implementing the latest evidence-based recommendations.