{"title":"Anesthetic implications in hepatic transplantation.","authors":"J A Aldrete, E Goldman, T de Campo","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75737,"journal":{"name":"Contemporary anesthesia practice","volume":"4 ","pages":"111-22"},"PeriodicalIF":0.0,"publicationDate":"1981-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18061054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with liver disease have increased morbidity and mortality following general anesthesia and surgery when compared with the general population. The increase in mortality appears to be directly related to the severity of hepatic parenchymal cell failure and to the magnitude and duration of the surgical procedure. The importance of preoperative detection of subclinical liver disease by use of a variety of blood tests has been emphasized. However, with the exception of hepatitis B and non-A non-B hepatitis, a precise diagnosis of the exact cause of liver disease is usually less important to the anesthesiologist than is a full characterization of the severity of hepatic dysfunction. Recognition and understanding of the central metabolic role played by the liver in maintaining carbohydrate, fat, and protein homeostasis can help in predicting and managing abnormalities which may complicate the preoperative, interoperative, and postoperative periods. Liver failure after anesthesia and surgery is treated by the same management principles used for liver failure with acute hepatitis. The incidence of postoperative renal failure may be increased in patients who have severe hyperbilirubinemia and its occurrence should be differentiated from the hepatorenal syndrome. It should be understood that complications of portal hypertension may develop in the absence of overt hepatic parenchymal cell failure and that liver failure may occur without gross evidence of portal hypertension. Either situation must be recognized and treated as far in advance of surgery as possible. In general, elective surgery in the patient with liver disease should be delayed until consequences of hepatic parenchymal cell dysfunction and portal hypertension are optimally corrected.
{"title":"Medical evaluation of the patient with liver disease prior to surgery.","authors":"C R Blundell, D L Earnest","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Patients with liver disease have increased morbidity and mortality following general anesthesia and surgery when compared with the general population. The increase in mortality appears to be directly related to the severity of hepatic parenchymal cell failure and to the magnitude and duration of the surgical procedure. The importance of preoperative detection of subclinical liver disease by use of a variety of blood tests has been emphasized. However, with the exception of hepatitis B and non-A non-B hepatitis, a precise diagnosis of the exact cause of liver disease is usually less important to the anesthesiologist than is a full characterization of the severity of hepatic dysfunction. Recognition and understanding of the central metabolic role played by the liver in maintaining carbohydrate, fat, and protein homeostasis can help in predicting and managing abnormalities which may complicate the preoperative, interoperative, and postoperative periods. Liver failure after anesthesia and surgery is treated by the same management principles used for liver failure with acute hepatitis. The incidence of postoperative renal failure may be increased in patients who have severe hyperbilirubinemia and its occurrence should be differentiated from the hepatorenal syndrome. It should be understood that complications of portal hypertension may develop in the absence of overt hepatic parenchymal cell failure and that liver failure may occur without gross evidence of portal hypertension. Either situation must be recognized and treated as far in advance of surgery as possible. In general, elective surgery in the patient with liver disease should be delayed until consequences of hepatic parenchymal cell dysfunction and portal hypertension are optimally corrected.</p>","PeriodicalId":75737,"journal":{"name":"Contemporary anesthesia practice","volume":"4 ","pages":"123-69"},"PeriodicalIF":0.0,"publicationDate":"1981-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18061055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anesthesia and biliary atresia.","authors":"J A Aldrete, J A Fisher, J Lilly","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75737,"journal":{"name":"Contemporary anesthesia practice","volume":"4 ","pages":"77-86"},"PeriodicalIF":0.0,"publicationDate":"1981-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18061058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hepatic blood flow alterations during anesthesia and surgery.","authors":"D D Alfery, J L Benumof","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75737,"journal":{"name":"Contemporary anesthesia practice","volume":"4 ","pages":"31-56"},"PeriodicalIF":0.0,"publicationDate":"1981-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18061056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although the coagulopathies encountered in patients with liver disease can be multifactorial, the most common cause is underproduction of certain coagulation factors synthesized by the liver. Generally, vitamin K and replacement therapy are all that is necessary. In the rare instance in which the coagulopathy may be complicated by hyperfibrinolysis or disseminated intravascular coagulation, replacement therapy may not suffice and other means of correcting the defect may be necessary. The prothrombin time, partial thromboplastin time, platelet count, fibrinogen concentration, and a test for fibrinolysis are recommended as the initial workup for the bleeding patient with underlying liver disease. Other, more specific tests may be necessary to differentiate the various causes of the defects in the hemostatic mechanism in these patients.
{"title":"Diagnosis and therapy of coagulopathies in patients with liver disease.","authors":"J J Corrigan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Although the coagulopathies encountered in patients with liver disease can be multifactorial, the most common cause is underproduction of certain coagulation factors synthesized by the liver. Generally, vitamin K and replacement therapy are all that is necessary. In the rare instance in which the coagulopathy may be complicated by hyperfibrinolysis or disseminated intravascular coagulation, replacement therapy may not suffice and other means of correcting the defect may be necessary. The prothrombin time, partial thromboplastin time, platelet count, fibrinogen concentration, and a test for fibrinolysis are recommended as the initial workup for the bleeding patient with underlying liver disease. Other, more specific tests may be necessary to differentiate the various causes of the defects in the hemostatic mechanism in these patients.</p>","PeriodicalId":75737,"journal":{"name":"Contemporary anesthesia practice","volume":"4 ","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"1981-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18242157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1981-01-01DOI: 10.7326/0003-4819-95-3-400_2
B. R. Brown
Once upon a time, not so long ago, anesthetic knowledge (at least for examination purposes) came from the "textbook"; usually this was a single author or departmental effort. Lately, these textbooks have grown in size and number of authors, the gestation period and cost have increased, and the content has become increasingly general in nature. For the anesthetist in search of a detailed review of a topic, the only recourse up until now has been the anesthesia journals or an occasional monograph. These latter sources are not always readily available, particularly for those without easy access to a medical library. Most recently, the series books have begun to appear. These books have focused on particular anesthetic problems, usually clinically orientated, with a supervising editor and a number of contributions from experts in the field. Anesthesia and the Patient with Liver Disease is such an example. To try to cover liver disease in nine chapters and 184 pages is overly optimistic; therefore, quite severe compromises have been made. Although many topics have been covered, the major problem with the book is the order of presentation. For example, postoperative jaundice occupies chapter 2, yet one has to wait until page 164 to find the assessment table for preoperative liver function and the predicted results of anesthesia and surgery. Rarities seem to have been given more emphasis than those problems that the anesthetist, working in a nonspecialized hospital, is
{"title":"Anesthesia and the patient with liver disease.","authors":"B. R. Brown","doi":"10.7326/0003-4819-95-3-400_2","DOIUrl":"https://doi.org/10.7326/0003-4819-95-3-400_2","url":null,"abstract":"Once upon a time, not so long ago, anesthetic knowledge (at least for examination purposes) came from the \"textbook\"; usually this was a single author or departmental effort. Lately, these textbooks have grown in size and number of authors, the gestation period and cost have increased, and the content has become increasingly general in nature. For the anesthetist in search of a detailed review of a topic, the only recourse up until now has been the anesthesia journals or an occasional monograph. These latter sources are not always readily available, particularly for those without easy access to a medical library. Most recently, the series books have begun to appear. These books have focused on particular anesthetic problems, usually clinically orientated, with a supervising editor and a number of contributions from experts in the field. Anesthesia and the Patient with Liver Disease is such an example. To try to cover liver disease in nine chapters and 184 pages is overly optimistic; therefore, quite severe compromises have been made. Although many topics have been covered, the major problem with the book is the order of presentation. For example, postoperative jaundice occupies chapter 2, yet one has to wait until page 164 to find the assessment table for preoperative liver function and the predicted results of anesthesia and surgery. Rarities seem to have been given more emphasis than those problems that the anesthetist, working in a nonspecialized hospital, is","PeriodicalId":75737,"journal":{"name":"Contemporary anesthesia practice","volume":"4 1","pages":"1-184"},"PeriodicalIF":0.0,"publicationDate":"1981-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71219634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiovascular data can provide the anesthesiologist with very valuable information that enables him to take better care of his patient. This information will prove even more valuable if the following few rules are followed: (1) do not be mesmerized, confused, or preoccupied by complex equipment, (2) do not avoid paying direct attention to your patient, (3) remember to use what will provide clinically useful information and heed this information, and (4) remember that electronic monitoring is not always superior to other methods.
{"title":"Monitoring the cardiovascular system during anesthesia.","authors":"C D Blitt","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cardiovascular data can provide the anesthesiologist with very valuable information that enables him to take better care of his patient. This information will prove even more valuable if the following few rules are followed: (1) do not be mesmerized, confused, or preoccupied by complex equipment, (2) do not avoid paying direct attention to your patient, (3) remember to use what will provide clinically useful information and heed this information, and (4) remember that electronic monitoring is not always superior to other methods.</p>","PeriodicalId":75737,"journal":{"name":"Contemporary anesthesia practice","volume":"2 ","pages":"19-37"},"PeriodicalIF":0.0,"publicationDate":"1980-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18051644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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