Anaes · Perioperative medicine
Hepatic failure and liver transplant anaesthesia
Also known as Cirrhosis anaesthesia · Acute liver failure anaesthesia · Liver transplant phases · MELD score anaesthesia · Hepatic coagulopathy rebalanced haemostasis
Exam-pass hepatic failure and liver transplant anaesthesia: ALF vs cirrhosis, MELD, rebalanced coagulopathy, encephalopathy, transplant phases high-level, drug dosing, and ICU priorities for ANZCA Final and equivalents.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- Chasing a high INR with plasma in a non-bleeding cirrhotic patient wastes product and volume-loads without fixing 'rebalanced' haemostasis.
- Acute liver failure with high-grade encephalopathy can have intracranial hypertension — treat like a neurocritical patient.
- Reperfusion can cause profound vasoplegia, hyperkalaemia, and acidosis — anticipate before unclamping.
- Benzodiazepines and high-dose opioids linger and worsen encephalopathy.
- Suxamethonium: expect prolonged block if plasma cholinesterase low; still may be used with plan.
Meet the patient
A 54-year-old man with alcohol-related cirrhosis, MELD 22, comes for an emergency laparotomy with peritonitis. His INR is 2.1 and he is not actively bleeding. The registrar wants to correct the INR with fresh-frozen plasma before induction — the recurring trainee move this topic exists to correct.[1]
Three questions decide every hepatic stem: is this acute liver failure or cirrhosis?, does this INR actually predict bleeding? (no — not alone), and which transplant-phase storm must I pre-empt? Hold those three and the long case and the transplant viva both fall into place.[1]
References4ShowHide
- [1]Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease Hepatology, 2001.PMID 11172350
- [2]Spahn DR, Bouillon B, Cerny V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition Crit Care, 2019.PMID 30917843
- [3]Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery N Engl J Med, 2017.PMID 29130845
- [4]Holcomb JB, Tilley BC, Baraniuk S, 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