Providing anesthetic care to a patient undergoing liver transplantation is one of the most challenging tasks for an anesthesiologist. Liver transplantation is a complex and formidable procedure, frequently involving major hemodynamic changes due to preload and afterload changes, massive blood loss, coagulation changes, acid-base changes, and electrolyte changes (hyperkalemia, hypocalcemia) of magnitudes that are unseen in any other procedure. Furthermore, patients with severe liver disease may have significant dysfunction of several other organ systems. Proper management starts with an appropriate and complete preoperative work-up; however, only the issues that are of significant importance for the anesthetic management of patients undergoing liver transplantation will be discussed here.
In patients with acute or subacute liver failure requiring urgent transplantation there is little time to do an extensive preoperative evaluation. Most patients however have to wait a significant amount of time for their transplant, and therefore evaluation should be complete. Anesthesiologists should be part of the multidisciplinary team determining appropriate candidacy for transplantation for patients with severe liver disease.
Patients with severe liver disease have a hyperdynamic circulation, with a high cardiac output and a low systemic vascular resistance. The systemic vasodilation
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