| Abstract: |
liver is the largest solid organ in the human body which has a plenty of functions essential for sound life. The liver lies in the right upper quadrant of the abdomen. Knowledge of segmental anatomy and blood supply of the liver help for advanced surgical procedures and allow graft taking from living donors. Liver transplantation involves the substitution of a diseased liver with a normal liver or part of one taken from a deceased or living donor, which has become an acceptable therapy for end stage liver disease in children and adults. The first human liver transplantation was performed in United States by Starzl in 1963. Over many years passed since the first ground breaking step were taken, and the results have been so remarkable that liver transplantation is now considered the treatment of choice for many patients suffering from acute or chronic liver disease. Liver transplantation is indicated for adult and children with acute or chronic liver disease that cannot be treated medically or with alternative forms of surgery. The most common indications for liver transplantation are cirrhosis (viral, alcohol-related and cryptogenic), cholestatic liver disease, metabolic liver disease, acute liver failure, liver tumors and other forms of liver disease. Absolute contraindications for liver transplantation include active sepsis or malignancy outside the liver and advanced hepato-renal or pulmonary dysfunction. Patients with liver dysfunction undergo a progressive deterioration affecting all organ system to some degree, so need preoperative assessment which may be very difficult and may not be closer to the date of transplantation. End-stage liver-diseased patients undergoing liver transplantation needing special intraoperative considerations that must be kept in mind. Careful monitoring of patient’s hemodynamics; including heart rate and rhythm, invasive blood pressure, central venous pressure and even pulmonary artery pressure and transesophageal echocardiography in selected patients. Temperature monitoring is essential to maintain normothermia of the patient throughout the operation. Also frequent monitoring of blood gases, electrolytes, blood sugars and coagulation is mandatory. Intra and post operative complications should be managed effectively for ensuring successful operation. Acknowledge of the technique and sequence of events, as well as the common complications of anaesthesia for liver transplantation are mandatory for every intensivist managing the patient postoperatively. Combining new methods of immunosuppression with modification in surgical technique, survival rate have reached 80% to 90% in many centers performing liver transplantation. The main source of organs was cadaveric donors, but with increasing patients with end-stage liver disease and organ shortage organs from living donors are accepted. However, living donors still cannot cover organ shortage so donation becomes accepted with criteria that were previously unaccepted. Anaesthetic care includes the intensive management of the organ donor Objectives : The aim of work is to highlight spots on the perioperative anaesthetic management of liver transplantation surgery including: anatomy of the liver, pathophysiology of the liver, indications and contraindications of liver transplantation, preanaesthetic considerations, intraoperative anaesthetic technique and monitoring, postoperative considerations and monitoring, complications after liver transplantation, anaesthetic management for the donor and anaesthetia for patient after liver transplantation.
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