Perioperative liver protection

Current Opinion in Critical Care
C BeckO Picker

Abstract

This review presents important pathophysiological alterations associated with impaired liver function and discusses protective perioperative strategies and the various anaesthetic agents recommended. Perioperative liver impairment is a serious complication of anaesthesia and surgery. Unfortunately, clinicians are provided with only crude macrohaemodynamic monitoring devices to optimize their therapy. Technical improvements have revealed some complex mysteries of perioperative microcirculatory alterations and have disclosed a large heterogeneity between different vascular beds. The present review will critically discuss current clinical concepts of optimizing global haemodynamic variables and the often contrasting effects of vasoactive agents on the microcirculatory nutritional blood flow. Finally, promising protective experimental interventions of pharmacological or ischaemic preconditioning are presented and their often disillusioning transition into recent clinical trials is highlighted. Targeted perioperative liver protection still lacks adequate monitoring tools and is currently based on optimization of global haemodynamic variables. While there is currently no evidence suggesting a positive effect of ischaemic precondition...Continue Reading

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Citations

Sep 22, 2015·Frontiers in Surgery·Geoffrey P Dobson
May 10, 2020·JPEN. Journal of Parenteral and Enteral Nutrition·Javier Mateu-de AntonioMaría Teresa Vitales-Farrero
Jul 25, 2017·Journal of Managed Care & Specialty Pharmacy·Yujin ParkJohn Ko

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