Severe perioperative bleeding increases perioperative morbidity and mortality. The management of the consequences imposes high burden on the human and financial resources of healthcare providers. Since 2009, there has been a continued worldwide decline in demand for allogenic blood products. This tendency can mainly be attributed to Perioperative Blood Management Program and to new innovative management applying haemostatic factor concentrates, viscoelastic assays and guidelines for treatment of the severe periprocedural bleeding patients. One of the major challenges of our times is still to match blood supply with demand. The new diagnostic and therapeutic modalities for managing the bleeding patients require new financial resources on the one hand and, on the other hand, call for redistribution of the material means provided by the health care system. Achieving interoperability between financial resources allocated to allogenic blood products and factor concentrates, the current state-of-the-art approach for managing the bleeding patient can be used to save blood and the lives of patients simultaneously. Orv Hetil. 2019; 160(6): 203–213.
After the detailed evaluation resection can be limited to an extent which is oncologically radical enough (1% remnant liver tissue/kg) and spares parenchyma which can ensure survival yet. With careful preoperative examination mortality can be reduced even to reach zero.
The living related donor mortality after liver donation could occur as a result of postoperative cardiovascular and thromboembolic complication; which could be minimized by detailed preoperative assessment of the living donor. The preoperative functional tests evaluate the physiological reserve or identify the living donors with limited response to the surgical stress. Based on the results of CT volumetry, MRI and liver functional reserve capacity test (indocyanine green retention ratio) the liver resection can be done safely. The preoperative cytochrome P enzymes tests of donors identify the drugs with abnormal metabolism. Balanced anesthesia combined with thoracic epidural anesthesia is done with liver safe, renal safe and ischemic preconditioning drugs. Normovolemic state is maintained with physiologic extrahepatic perfusion and oxygenation conditions. The central venous and hepatic artery pressure is reduced with the guarantee of optimal hepatic perfusion-oxygenation and better liver resection condition. Intraoperative thrombosis prophylaxis is performed with sequential compression device. After liver resection the donor morbidity can be reduced, effective analgesia, thrombosis prophylaxis, liver safe drug therapy and a tight monitoring. Before the first postoperative mobilization a deep vein Doppler ultrasound control is proposed.
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