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Perioperatives anästhesiologisches Management bei ausgedehnten Leberteilresektionen

Pathophysiologie der Lebererkrankungen und funktionelle Zeichen des Leberversagens

Perioperative anesthesia management of extended partial liver resection

Pathophysiology of hepatic diseases and functional signs of hepatic failure

  • Leitthema
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Zusammenfassung

Die Bedeutung der Leberteilresektion als potenziell kurative Therapie bei Tumoren der Leber hat in den letzten Jahrzehnten zugenommen. Verantwortlich hierfür sind einerseits eine gesunkene perioperative Letalität und Morbidität durch Fortschritte im chirurgischen und anästhesiologischen Management sowie andererseits die gestiegene Inzidenz von hepatozellulären Karzinomen. Heute wird die Leberteilresektion in Zentren regelhaft und sicher durchgeführt. Dieser Beitrag beschreibt zunächst die pathophysiologischen Veränderungen, die bei einer Leberinsuffizienz und nach ausgedehnten Leberteilresektionen auftreten können, und gibt Empfehlungen zur präoperativen Abklärung der Patienten. Im zweiten Teil wird das perioperative anästhesiologische Management dargestellt, unter Berücksichtigung von Besonderheiten der Narkoseführung, des Volumenmanagements, der Techniken zur Verringerung des Blutverlusts, der perioperativen Analgesie und der postoperativen Intensivtherapie.

Abstract

The importance of partial liver resection as a therapeutic option to cure hepatic tumors has increased over the last decades. This has been influenced on the one hand by advances in surgical and anesthetic management resulting in a reduced mortality after surgery and on the other hand by an increased incidence of hepatocellular carcinoma. Nowadays, partial resection of the liver is performed safely and as a routine operation in specialized centers. This article describes the pathophysiological changes secondary to liver failure and assesses the perioperative management of patients undergoing partial or extended liver resection. It looks in detail at the preoperative assessment, the intraoperative anesthetic management including fluid management and techniques to reduce blood loss as well as postoperative analgesia and intensive care therapy.

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Literatur

  1. Abrams GA, Rose K, Fallon MB et al (1999) Hepatopulmonary syndrome and venous emboli causing intracerebral hemorrhages after liver transplantation: a case report. Transplantation 68:1809–1811

    Article  CAS  PubMed  Google Scholar 

  2. Akpek EA, Arslan G, Erkaya C et al (2003) Anesthetic risks for donors in living-related liver transplantation: analysis of 30 cases. Transpl Int 16:486–490

    Article  PubMed  Google Scholar 

  3. Arroyo V, Gines P, Gerbes AL et al (1996) Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Hepatology 23:164–176

    Article  CAS  PubMed  Google Scholar 

  4. Asahara T, Katayama K, Itamoto T et al (1999) Perioperative blood transfusion as a prognostic indicator in patients with hepatocellular carcinoma. World J Surg 23:676–680

    Article  CAS  PubMed  Google Scholar 

  5. Beck-Schimmer B, Breitenstein S, Urech S et al (2008) A randomized controlled trial on pharmacological preconditioning in liver surgery using a volatile anesthetic. Ann Surg 248:909–918

    Article  PubMed  Google Scholar 

  6. Beebe DS, Carr R, Komanduri V et al (2000) Living liver donor surgery: report of initial anesthesia experience. J Clin Anesth 12:157–161

    Article  CAS  PubMed  Google Scholar 

  7. Beers R, Camporesi E (2004) Remifentanil update: clinical science and utility. CNS Drugs 18:1085–1104

    Article  CAS  PubMed  Google Scholar 

  8. Belghiti J, Noun R, Malafosse R et al (1999) Continuous versus intermittent portal triad clamping for liver resection: a controlled study. Ann Surg 229:369–375

    Article  CAS  PubMed  Google Scholar 

  9. Belghiti J, Panis Y, Farges O et al (1991) Intrahepatic recurrence after resection of hepatocellular carcinoma complicating cirrhosis. Ann Surg 214:114–117

    Article  CAS  PubMed  Google Scholar 

  10. Berthelot P, Walker JG, Sherlock S, Reid L (1966) Arterial changes in the lungs in cirrhosis of the liver-lung spider nevi. N Engl J Med 274:291–298

    Article  CAS  PubMed  Google Scholar 

  11. Blumberg N, Heal JM (1994) Effects of transfusion on immune function. Cancer recurrence and infection. Arch Pathol Lab Med 118:371–379

    CAS  PubMed  Google Scholar 

  12. Bezeaud A, Denninger MH, Dondero F et al (2007) Hypercoagulability after partial liver resection. Thromb Haemost 98:1252–1256

    CAS  PubMed  Google Scholar 

  13. Borromeo CJ, Stix MS, Lally A, Pomfret EA (2000) Epidural catheter and increased prothrombin time after right lobe hepatectomy for living donor transplantation. Anesth Analg 91:1139–1141

    Article  CAS  PubMed  Google Scholar 

  14. Boyer TD, Zia P, Reynolds TB (1979) Effect of indomethacin and prostaglandin A1 on renal function and plasma renin activity in alcoholic liver disease. Gastroenterology 77:215–222

    CAS  PubMed  Google Scholar 

  15. Brodner G, Van Aken H, Gogarten W (2007) Regional anesthesia for postoperative pain control. Anasthesiol Intensivmed Notfallmed Schmerzther 42:32–41

    Article  PubMed  Google Scholar 

  16. Cammu G, Troisi R, Cuomo O et al (2002) Anaesthetic management and outcome in right-lobe living liver-donor surgery. Eur J Anaesthesiol 19:93–98

    CAS  PubMed  Google Scholar 

  17. Castro M, Krowka MJ, Schroeder DR et al (1996) Frequency and clinical implications of increased pulmonary artery pressures in liver transplant patients. Mayo Clin Proc 71:543–551

    Article  CAS  PubMed  Google Scholar 

  18. Chhibber A, Dziak J, Kolano J et al (2007) Anesthesia care for adult live donor hepatectomy: our experiences with 100 cases. Liver Transpl 13:537–542

    Article  PubMed  Google Scholar 

  19. Chiang ST (1968) A nomogram for venous shunt (Qs-Qt) calculation. Thorax 23:563–565

    Article  CAS  PubMed  Google Scholar 

  20. Choi SJ, Gwak MS, Ko JS et al (2007) The changes in coagulation profile and epidural catheter safety for living liver donors: a report on 6 years of our experience. Liver Transpl 13:62–70

    Article  PubMed  Google Scholar 

  21. Choudhry DK, Schwartz RE, Stayer SA et al (1999) Anesthetic management of living liver donors. Can J Anaesth 46:788–791

    Article  CAS  PubMed  Google Scholar 

  22. Claria J, Jimenez W, Ros J et al (1992) Pathogenesis of arterial hypotension in cirrhotic rats with ascites: role of endogenous nitric oxide. Hepatology 15:343–349

    Article  CAS  PubMed  Google Scholar 

  23. Clavien PA, Selzner M, Rudiger HA et al (2003) A prospective randomized study in 100 consecutive patients undergoing major liver resection with versus without ischemic preconditioning. Ann Surg 238:843–850

    Article  PubMed  Google Scholar 

  24. Craig JR PR, Edmondson HA (1989) Tumors of the liver and intrahepatic bile ducts. Atlas of tumor pathology, 2nd series. Armed Forces Institute of Pathology, Washington DC

  25. Cywinski JB, Parker BM, Xu M, Irefin SA (2004) A comparison of postoperative pain control in patients after right lobe donor hepatectomy and major hepatic resection for tumor. Anesth Analg 99:1747–1752

    Article  PubMed  Google Scholar 

  26. De Boer MT, Molenaar IQ, Porte RJ (2007) Impact of blood loss on outcome after liver resection. Dig Surg 24:259–264

    Article  Google Scholar 

  27. De Ledinghen V, Heresbach D, Fourdan O et al (1999) Anti-inflammatory drugs and variceal bleeding: a case-control study. Gut 44:270–273

    Article  Google Scholar 

  28. De Wolf AM, Freeman JA, Scott VL et al (1996) Pharmacokinetics and pharmacodynamics of cisatracurium in patients with end-stage liver disease undergoing liver transplantation. Br J Anaesth 76:624–628

    Google Scholar 

  29. Delva E, Camus Y, Paugam C et al (1987) Hemodynamic effects of portal triad clamping in humans. Anesth Analg 66:864–868

    Article  CAS  PubMed  Google Scholar 

  30. Deng Z, Morse JH, Slager SL et al (2000) Familial primary pulmonary hypertension (gene PPH1) is caused by mutations in the bone morphogenetic protein receptor-II gene. Am J Hum Genet 67:737–744

    Article  CAS  PubMed  Google Scholar 

  31. De-Oliveira ML, Cunningham SC, Cameron JL et al (2007) Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg 245:755–762

    Article  Google Scholar 

  32. Durand F, Ettore GM, Douard R et al (2002) Donor safety in living related liver transplantation: underestimation of the risk for deep vein thrombosis and pulmonary embolism. Liver Transpl 8:118–120

    Article  PubMed  Google Scholar 

  33. Edwards WH Jr, Blumgart LH (1987) Liver resection in malignant disease. Semin Surg Oncol 3:1–11

    Article  CAS  PubMed  Google Scholar 

  34. El-Serag HB, Davila JA, Petersen NJ, McGlynn KA (2003) The continuing increase in the incidence of hepatocellular carcinoma in the United States: an update. Ann Intern Med 139:817–823

    PubMed  Google Scholar 

  35. Fallon MB (2000) Methylene blue and cirrhosis: pathophysiologic insights, therapeutic dilemmas. Ann Intern Med 133:738–740

    CAS  PubMed  Google Scholar 

  36. Fallon MB, Abrams GA, Luo B et al (1997) The role of endothelial nitric oxide synthase in the pathogenesis of a rat model of hepatopulmonary syndrome. Gastroenterology 113:606–614

    Article  CAS  PubMed  Google Scholar 

  37. Farges O, Malassagne B, Flejou JF et al (1999) Risk of major liver resection in patients with underlying chronic liver disease: a reappraisal. Ann Surg 229:210–215

    Article  CAS  PubMed  Google Scholar 

  38. Ferrier C, Marty J, Bouffard Y et al (1985) Alfentanil pharmacokinetics in patients with cirrhosis. Anesthesiology 62:480–484

    Article  CAS  PubMed  Google Scholar 

  39. Gatecel C, Losser MR, Payen D (2003) The postoperative effects of halothane versus isoflurane on hepatic artery and portal vein blood flow in humans. Anesth Analg 96:740–745

    Article  CAS  PubMed  Google Scholar 

  40. Geldner G, Kelm M, Leschke M et al (2010) Präoperative Evaluation erwachsener Patienten vor elektiven, nichtkardiochirurgischen Eingriffen Gemeinsame Empfehlung der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, der Deutschen Gesellschaft für Chirurgie und der Deutschen Gesellschaft für Innere Medizin. Anaesthesist 59(11):1041–1050

    Article  Google Scholar 

  41. Gines P, Fernandez-Esparrach G, Arroyo V, Rodes J (1997) Pathogenesis of ascites in cirrhosis. Semin Liver Dis 17:175–189

    Article  CAS  PubMed  Google Scholar 

  42. Gines P, Guevara M, Arroyo V, Rodes J (2003) Hepatorenal syndrome. Lancet 362:1819–1827

    Article  CAS  PubMed  Google Scholar 

  43. Gluud LL, Kjaer MS, Christensen E (2006) Terlipressin for hepatorenal syndrome. Cochrane Database Syst Rev:CD005162

    Google Scholar 

  44. Gogarten W, Buerkle H, Büttner J et al (2007) Rückenmarksnahe Regionalanästhesien und Thromboembolieprophylaxe/antithrombotische Medikation. Anaesthesiol Intensivmed 48:S109–S124

    Google Scholar 

  45. Gomez FP, Martinez-Palli G, Barbera JA et al (2004) Gas exchange mechanism of orthodeoxia in hepatopulmonary syndrome. Hepatology 40:660–666

    Article  PubMed  Google Scholar 

  46. Goulis J, Chau TN, Jordan S et al (1999) Thrombopoietin concentrations are low in patients with cirrhosis and thrombocytopenia and are restored after orthotopic liver transplantation. Gut 44:754–758

    Article  CAS  PubMed  Google Scholar 

  47. Guarner C, Soriano G, Tomas A et al (1993) Increased serum nitrite and nitrate levels in patients with cirrhosis: relationship to endotoxemia. Hepatology 18:1139–1143

    Article  CAS  PubMed  Google Scholar 

  48. Gurusamy KS, Li J, Sharma D et al (2009) Cardiopulmonary interventions to decrease blood loss and blood transfusion requirements for liver resection. Cochrane Database Syst Rev:CD007338

    Google Scholar 

  49. Haberer JP, Schoeffler P, Couderc E, Duvaldestin P (1982) Fentanyl pharmacokinetics in anaesthetized patients with cirrhosis. Br J Anaesth 54:1267–1270

    Article  CAS  PubMed  Google Scholar 

  50. Hadengue A, Benhayoun MK, Lebrec D, Benhamou JP (1991) Pulmonary hypertension complicating portal hypertension: prevalence and relation to splanchnic hemodynamics. Gastroenterology 100:520–528

    CAS  PubMed  Google Scholar 

  51. Hatano Y, Murakawa M, Segawa H et al (1990) Venous air embolism during hepatic resection. Anesthesiology 73:1282–1285

    Article  CAS  PubMed  Google Scholar 

  52. Hoeper MM, Krowka MJ, Strassburg CP (2004) Portopulmonary hypertension and hepatopulmonary syndrome. Lancet 363:1461–1468

    Article  PubMed  Google Scholar 

  53. Holaday DA, Fiserova-Bergerova V, Latto IP, Zumbiel MA (1975) Resistance of isoflurane to biotransformation in man. Anesthesiology 43:325–332

    Article  CAS  PubMed  Google Scholar 

  54. Hori N, Wiest R, Groszmann RJ (1998) Enhanced release of nitric oxide in response to changes in flow and shear stress in the superior mesenteric arteries of portal hypertensive rats. Hepatology 28:1467–1473

    Article  CAS  PubMed  Google Scholar 

  55. Iwakiri Y, Groszmann RJ (2006) The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule. Hepatology 43 (2 Suppl 1):121–131

    Article  CAS  Google Scholar 

  56. Jaeck D, Bachellier P, Oussoultzoglou E et al (2004) Surgical resection of hepatocellular carcinoma. Post-operative outcome and long-term results in Europe: an overview. Liver Transpl 10:S58–S63

    Article  PubMed  Google Scholar 

  57. Jarnagin WR, Gonen M, Fong Y et al (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 236:397–406; discussion 406–397

    Article  PubMed  Google Scholar 

  58. Johnson M, Mannar R, Wu AV (1998) Correlation between blood loss and inferior vena caval pressure during liver resection. Br J Surg 85:188–190

    Article  CAS  PubMed  Google Scholar 

  59. Jonas S, Thelen A, Benckert C, Neuhaus P (2004) Surgical resection of colorectal metastases. Front Radiat Ther Oncol 38:94–99

    Article  PubMed  Google Scholar 

  60. Jones RM, Moulton CE, Hardy KJ (1998) Central venous pressure and its effect on blood loss during liver resection. Br J Surg 85:1058–1060

    Article  CAS  PubMed  Google Scholar 

  61. Koo BN, Kil HK, Choi JS et al (2005) Hepatic resection by the Cavitron Ultrasonic Surgical Aspirator increases the incidence and severity of venous air embolism. Anesth Analg 101:966–970

    Article  PubMed  Google Scholar 

  62. Kooby DA, Stockman J, Ben-Porat L et al (2003) Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg 237:860–869

    Article  PubMed  Google Scholar 

  63. Lange PA, Stoller JK (1996) The hepatopulmonary syndrome: effect of liver transplantation. Clin Chest Med 17:115–123

    Article  CAS  PubMed  Google Scholar 

  64. Le Pavec J, Souza R, Herve P et al (2008) Portopulmonary hypertension: survival and prognostic factors. Am J Respir Crit Care Med 178:637–643

    Article  Google Scholar 

  65. Lee SY, Choi BI, Kim JS, Park KS (2002) Paradoxical air embolism during hepatic resection. Br J Anaesth 88:136–138

    Article  CAS  PubMed  Google Scholar 

  66. Lehmann A, Neher M, Kiessling AH et al (2007) Case report: fatal hepatic failure after aortic valve replacement and sevoflurane exposure. Can J Anaesth 54:917–921

    Article  PubMed  Google Scholar 

  67. Lenz K, Hortnagl H, Druml W et al (1991) Ornipressin in the treatment of functional renal failure in decompensated liver cirrhosis. Effects on renal hemodynamics and atrial natriuretic factor. Gastroenterology 101:1060–1067

    CAS  PubMed  Google Scholar 

  68. Lisman T, Bongers TN, Adelmeijer J et al (2006) Elevated levels of von Willebrand factor in cirrhosis support platelet adhesion despite reduced functional capacity. Hepatology 44:53–61

    Article  CAS  PubMed  Google Scholar 

  69. Lo CM (2003) Complications and long-term outcome of living liver donors: a survey of 1,508 cases in five Asian centers. Transplantation 75 (3 Suppl):12–15

    Article  Google Scholar 

  70. Luo B, Liu L, Tang L et al (2003) Increased pulmonary vascular endothelin B receptor expression and responsiveness to endothelin-1 in cirrhotic and portal hypertensive rats: a potential mechanism in experimental hepatopulmonary syndrome. J Hepatol 38:556–563

    Article  CAS  PubMed  Google Scholar 

  71. Lutz JT, Valentin-Gamazo C, Gorlinger K et al (2003) Blood-transfusion requirements and blood salvage in donors undergoing right hepatectomy for living related liver transplantation. Anesth Analg 96:351–355

    Article  PubMed  Google Scholar 

  72. Mannucci PM (2006) Abnormal hemostasis tests and bleeding in chronic liver disease: are they related? No. J Thromb Haemost 4:721–723

    Article  CAS  PubMed  Google Scholar 

  73. Martin JL (2005) Volatile anesthetics and liver injury: a clinical update or what every anesthesiologist should know. Can J Anaesth 52:125–129

    Article  PubMed  Google Scholar 

  74. Martin RC, Jarnagin WR, Fong Y et al (2003) The use of fresh frozen plasma after major hepatic resection for colorectal metastasis: is there a standard for transfusion? J Am Coll Surg 196:402–409

    Article  PubMed  Google Scholar 

  75. Melendez JA, Arslan V, Fischer ME et al (1998) Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg 187:620–625

    Article  CAS  PubMed  Google Scholar 

  76. Merin RG, Bernard JM, Doursout MF et al (1991) Comparison of the effects of isoflurane and desflurane on cardiovascular dynamics and regional blood flow in the chronically instrumented dog. Anesthesiology 74:568–574

    Article  CAS  PubMed  Google Scholar 

  77. Minakata Y, Sugiura H, Yamagata T et al (2008) Prevalence of COPD in primary care clinics: correlation with non-respiratory diseases. Intern Med 47:77–82

    Article  PubMed  Google Scholar 

  78. Moen V, Dahlgren N, Irestedt L (2004) Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anesthesiology 101:950–959

    Article  CAS  PubMed  Google Scholar 

  79. Morales-Ruiz M, Jimenez W, Perez-Sala D et al (1996) Increased nitric oxide synthase expression in arterial vessels of cirrhotic rats with ascites. Hepatology 24:1481–1486

    Article  CAS  PubMed  Google Scholar 

  80. Morsiani E, Aleotti A, Ricci D (1998) Haemodynamic and ultrastructural observations on the rat liver after two-thirds partial hepatectomy. J Anat 192:507–515

    Article  PubMed  Google Scholar 

  81. Nakagohri T, Kinoshita T, Konishi M et al (2008) surgical outcome and prognostic factors in intrahepatic cholangiocarcinoma. World J Surg 32:2675–2680

    Article  PubMed  Google Scholar 

  82. Nishiyama T, Fujimoto T, Hanaoka K (2004) A comparison of liver function after hepatectomy in cirrhotic patients between sevoflurane and isoflurane in anesthesia with nitrous oxide and epidural block. Anesth Analg 98:990–993

    Article  CAS  PubMed  Google Scholar 

  83. Njoku D, Laster MJ, Gong DH et al (1997) Biotransformation of halothane, enflurane, isoflurane, and desflurane to trifluoroacetylated liver proteins: association between protein acylation and hepatic injury. Anesth Analg 84:173–178

    Article  CAS  PubMed  Google Scholar 

  84. Opelz G, Terasaki PI (1976) Prolongation effect of blood transfusions on kidney graft survival. Transplantation 22:380–383

    Article  CAS  PubMed  Google Scholar 

  85. O’Riordan J, O’Beirne HA, Young Y, Bellamy MC (1997) Effects of desflurane and isoflurane on splanchnic microcirculation during major surgery. Br J Anaesth 78:95–96

    Google Scholar 

  86. Pandele G, Chaux F, Salvadori C et al (1983) Thiopental pharmacokinetics in patients with cirrhosis. Anesthesiology 59:123–126

    Article  CAS  PubMed  Google Scholar 

  87. Paul D, Standifer KM, Inturrisi CE, Pasternak GW (1989) Pharmacological characterization of morphine-6 beta-glucuronide, a very potent morphine metabolite. J Pharmacol Exp Ther 251:477–483

    CAS  PubMed  Google Scholar 

  88. Pinzani M, Milani S, De Franco R et al (1996) Endothelin 1 is overexpressed in human cirrhotic liver and exerts multiple effects on activated hepatic stellate cells. Gastroenterology 110:534–548

    Article  CAS  PubMed  Google Scholar 

  89. Pulitano C, Aldrighetti L, Arru M et al (2007) Preoperative methylprednisolone administration maintains coagulation homeostasis in patients undergoing liver resection: importance of inflammatory cytokine modulation. Shock 28:401–405

    Article  CAS  PubMed  Google Scholar 

  90. Rasaratnam B, Kaye D, Jennings G et al (2003) The effect of selective intestinal decontamination on the hyperdynamic circulatory state in cirrhosis: a randomized trial. Ann Intern Med 139:186–193

    PubMed  Google Scholar 

  91. Reverter JC (2006) Abnormal hemostasis tests and bleeding in chronic liver disease: are they related? Yes. J Thromb Haemost 4:717–720

    Article  CAS  PubMed  Google Scholar 

  92. Rigg JR, Jamrozik K, Myles PS et al (2002) Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 359:1276–1282

    Article  PubMed  Google Scholar 

  93. Ritter DM, Rettke SR, Ilstrup DM, Burritt MF (1988) Effect of plasma cholinesterase activity on the duration of action of succinylcholine in patients with genotypically normal enzyme. Anesth Analg 67:1123–1126

    CAS  PubMed  Google Scholar 

  94. Rodriguez-Roisin R, Krowka MJ, Herve P, Fallon MB (2004) Pulmonary-hepatic vascular disorders (PHD). Eur Respir J 24:861–880

    Article  CAS  PubMed  Google Scholar 

  95. Rohrer MJ, Natale AM (1992) Effect of hypothermia on the coagulation cascade. Crit Care Med 20:1402–1405

    Article  CAS  PubMed  Google Scholar 

  96. Rolla G, Brussino L, Colagrande P et al (1997) Exhaled nitric oxide and oxygenation abnormalities in hepatic cirrhosis. Hepatology 26:842–847

    Article  CAS  PubMed  Google Scholar 

  97. Rosen CB, Nagorney DM, Taswell HF et al (1992) Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma. Ann Surg 216:493–504

    Article  CAS  PubMed  Google Scholar 

  98. Ruiz-del-Arbol L, Monescillo A, Arocena C et al (2005) Circulatory function and hepatorenal syndrome in cirrhosis. Hepatology 42:439–447

    Article  CAS  PubMed  Google Scholar 

  99. Salame E, Goldstein MJ, Kinkhabwala M et al (2002) Analysis of donor risk in living-donor hepatectomy: the impact of resection type on clinical outcome. Am J Transplant 2:780–788

    Article  PubMed  Google Scholar 

  100. Schenk P, Fuhrmann V, Madl C et al (2002) Hepatopulmonary syndrome: prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences. Gut 51:853–859

    Article  CAS  PubMed  Google Scholar 

  101. Schenk P, Madl C, Rezaie-Majd S et al (2000) Methylene blue improves the hepatopulmonary syndrome. Ann Intern Med 133:701–706

    CAS  PubMed  Google Scholar 

  102. Schumann R, Zabala L, Angelis M et al (2004) Altered hematologic profiles following donor right hepatectomy and implications for perioperative analgesic management. Liver Transpl 10:363–368

    Article  PubMed  Google Scholar 

  103. Servin F, Cockshott ID, Farinotti R et al (1990) Pharmacokinetics of propofol infusions in patients with cirrhosis. Br J Anaesth 65:177–183

    Article  CAS  PubMed  Google Scholar 

  104. Simonneau G, Galie N, Rubin LJ et al (2004) Clinical classification of pulmonary hypertension. J Am Coll Cardiol 43 (12 Suppl S):5–12

    Article  Google Scholar 

  105. Siniscalchi A, Begliomini B, De Pietri L et al (2004) Increased prothrombin time and platelet counts in living donor right hepatectomy: implications for epidural anesthesia. Liver Transpl 10:1144–1149

    Article  PubMed  Google Scholar 

  106. Smyrniotis V, Kostopanagiotou G, Theodoraki K et al (2004) The role of central venous pressure and type of vascular control in blood loss during major liver resections. Am J Surg 187:398–402

    Article  PubMed  Google Scholar 

  107. Soejima Y, Harada N, Shimada M et al (2002) Perioperative management and complications in donors related to living-donor liver transplantation. Surgery 131 (1 Suppl):195–199

    Article  Google Scholar 

  108. Soonawalla ZF, Stratopoulos C, Stoneham M et al (2008) Role of the reverse-Trendelenberg patient position in maintaining low-CVP anaesthesia during liver resections. Langenbecks Arch Surg 393:195–198

    Article  PubMed  Google Scholar 

  109. Sotiropoulos GC, Bockhorn M, Sgourakis G et al (2008) R0 liver resections for primary malignant liver tumors in the noncirrhotic liver: a diagnosis-related analysis. Dig Dis Sci 54(4):887–894

    Article  PubMed  Google Scholar 

  110. Suc B, Panis Y, Belghiti J, Fekete F (1992) „Natural history“ of hepatectomy. Br J Surg 79:39–42

    Article  CAS  PubMed  Google Scholar 

  111. Sutton TS, Koblin DD, Gruenke LD et al (1991) Fluoride metabolites after prolonged exposure of volunteers and patients to desflurane. Anesth Analg 73:180–185

    Article  CAS  PubMed  Google Scholar 

  112. Swanson KL, Wiesner RH, Krowka MJ (2005) Natural history of hepatopulmonary syndrome: impact of liver transplantation. Hepatology 41:1122–1129

    Article  PubMed  Google Scholar 

  113. Swanson KL, Wieser RH, Nyberg SL et al (2008) Survival in portopulmonary hypertension: Mayo Clinic experience categorized by treatment subgroups. Am J Transplant 8:2445–2453

    Article  CAS  PubMed  Google Scholar 

  114. Takaoka F, Teruya A, Massarollo P, Mies S (2003) Minimizing risks for donors undergoing right hepatectomy for living-related liver transplantation. Anesth Analg 97:297

    Article  PubMed  Google Scholar 

  115. Tegeder I, Lotsch J, Geisslinger G (1999) Pharmacokinetics of opioids in liver disease. Clin Pharmacokinet 37:17–40

    Article  CAS  PubMed  Google Scholar 

  116. Tripodi A, Salerno F, Chantarangkul V et al (2005) Evidence of normal thrombin generation in cirrhosis despite abnormal conventional coagulation tests. Hepatology 41:553–558

    Article  CAS  PubMed  Google Scholar 

  117. Tsui SL, Yong BH, Ng KF et al (2004) Delayed epidural catheter removal: the impact of postoperative coagulopathy. Anaesth Intensive Care 32:630–636

    CAS  PubMed  Google Scholar 

  118. Beem H van, Manger FW, Boxtel C van, Bentem N van (1983) Etomidate anaesthesia in patients with cirrhosis of the liver: pharmacokinetic data. Anaesthesia 38 (Suppl):61–62

    PubMed  Google Scholar 

  119. Miert MM van, Eastwood NB, Boyd AH et al (1997) The pharmacokinetics and pharmacodynamics of rocuronium in patients with hepatic cirrhosis. Br J Clin Pharmacol 44:139–144

    Article  PubMed  Google Scholar 

  120. Vauthey JN, Pawlik TM, Ribero D et al (2006) Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 24:2065–2072

    Article  CAS  PubMed  Google Scholar 

  121. Wang WD, Liang LJ, Huang XQ, Yin XY (2006) Low central venous pressure reduces blood loss in hepatectomy. World J Gastroenterol 12:935–939

    PubMed  Google Scholar 

  122. Wiest R, Das S, Cadelina G et al (1999) Bacterial translocation in cirrhotic rats stimulates eNOS-derived NO production and impairs mesenteric vascular contractility. J Clin Invest 104:1223–1233

    Article  CAS  PubMed  Google Scholar 

  123. Yong BH, Tsui SL, Leung CC et al (2000) Management of postoperative analgesia in living liver donors. Transplant Proc 32:2110

    Article  CAS  PubMed  Google Scholar 

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  1. Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité – Universitätsmedizin Berlin,Campus Virchow-Klinikum und Charité Mitte, Augustenburger Platz 1, 13353, Berlin, Deutschland

    S. Herz, C. Spies, D. Jörres &  C. von Heymann DEAA

  2. Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité- Universitätsmedizin Berlin, Campus Virchow-Klinikum und Charité Mitte, Berlin, Deutschland

    G. Puhl & P. Neuhaus

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  1. S. Herz
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  2. G. Puhl
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  3. C. Spies
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  4. D. Jörres
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  5. P. Neuhaus
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  6. C. von Heymann DEAA
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Correspondence to C. von Heymann DEAA.

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Herz, S., Puhl, G., Spies, C. et al. Perioperatives anästhesiologisches Management bei ausgedehnten Leberteilresektionen. Anaesthesist 60, 103–117 (2011). https://doi.org/10.1007/s00101-011-1852-9

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  • DOI: https://doi.org/10.1007/s00101-011-1852-9

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