Anaes SAQs · Perioperative medicine
Hepatic failure and liver transplant anaesthesia
Final-examination SAQ for hepatic-failure-liver-transplant.
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ANZCAFRCAEDAICABAFCAI
Prompt
Outline anaesthetic considerations for (a) decompensated cirrhosis undergoing emergency laparotomy and (b) high-level management differences across liver transplant phases.
Model answer
(a) Cirrhosis emergency (7). Stratify MELD components (bili/INR/creatinine); encephalopathy; ascites/aspiration; rebalanced haemostasis—do not FFP-chase INR alone; reduced drug doses; prefer organ-independent NMBA with NMM; arterial line/vasopressors; goal-directed products if bleeding; ICU.[1][2]
(b) Transplant phases (8). Dissection: bleeding/portal hypertension. Anhepatic: no metabolism, lactate/citrate issues. Reperfusion: hypotensive/hyperK/acidotic storm—calcium, pressors, communication. Massive transfusion principles if needed.[2][3]
References3ShowHide
- [1]Kamath PS et al. A model to predict survival in patients with end-stage liver disease. Hepatology, 2001.PMID 11172350
- [2]Spahn DR et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Critical Care, 2019.PMID 30917843
- [3]Holcomb JB et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA, 2015.PMID 25647203