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206 Organ Donation and Transplantation - Current Status and Future Challenges

**Chapter 11**

**Provisional chapter**

**Anesthesia for Liver Transplantation**

**Anesthesia for Liver Transplantation**

DOI: 10.5772/intechopen.75167

Liver transplantation is a high-risk surgery performed on a high-risk patient and is the only treatment for end-stage liver disease. Ever since the first successful liver transplant performed, patient survival increased due to improvement of surgical technique and anaesthetic management as well as the emergence of new generations of immunosuppressants. The pre-anaesthetic evaluation is mandatory and plays an important role in patient inclusion on the transplant list. Liver transplantation is performed under general anaesthesia, and the anaesthetic monitoring is very important for a successful liver transplantation as it can expose problems before irreversible damage occurs. Haemodynamic instability is common during surgery, requiring complex invasive haemodynamic monitoring. Continuous assessment of the patient's volemic status and the amount of perfused fluids represent the key to a successful liver transplantation. Inadequate fluid therapy can lead to pulmonary oedema, abnormal gas exchange, congestion, decrease in perfusion and oedema of the graft. Liver reperfusion takes place in the neohepatic phase and is the most unstable period during liver transplantation, representing a real challenge for the anaesthetist. It can have severe consequences due to a decrease in cardiovascular function with haemodynamic instability, abnormal acid base balance and metabolic abnormalities.

**Keywords:** liver transplant, cirrhotic cardiomyopathy, postreperfusion syndrome

Liver transplantation is the only treatment for end-stage liver disease regardless of its aetiology as well as for other categories of liver failure. The procedure is performed on a high-risk patient with impairment of cardiovascular, pulmonary, renal and coagulation systems. Due to increasingly good results, transplant candidates are older and frequently have co-morbidities.

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

Gabriela Droc and Lavinia Jipa

Gabriela Droc and Lavinia Jipa

http://dx.doi.org/10.5772/intechopen.75167

**Abstract**

**1. Introduction**

#### **Anesthesia for Liver Transplantation Anesthesia for Liver Transplantation**

Gabriela Droc and Lavinia Jipa Gabriela Droc and Lavinia Jipa

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.75167

#### **Abstract**

Liver transplantation is a high-risk surgery performed on a high-risk patient and is the only treatment for end-stage liver disease. Ever since the first successful liver transplant performed, patient survival increased due to improvement of surgical technique and anaesthetic management as well as the emergence of new generations of immunosuppressants. The pre-anaesthetic evaluation is mandatory and plays an important role in patient inclusion on the transplant list. Liver transplantation is performed under general anaesthesia, and the anaesthetic monitoring is very important for a successful liver transplantation as it can expose problems before irreversible damage occurs. Haemodynamic instability is common during surgery, requiring complex invasive haemodynamic monitoring. Continuous assessment of the patient's volemic status and the amount of perfused fluids represent the key to a successful liver transplantation. Inadequate fluid therapy can lead to pulmonary oedema, abnormal gas exchange, congestion, decrease in perfusion and oedema of the graft. Liver reperfusion takes place in the neohepatic phase and is the most unstable period during liver transplantation, representing a real challenge for the anaesthetist. It can have severe consequences due to a decrease in cardiovascular function with haemodynamic instability, abnormal acid base balance and metabolic abnormalities.

DOI: 10.5772/intechopen.75167

**Keywords:** liver transplant, cirrhotic cardiomyopathy, postreperfusion syndrome
