Perioperative Management of the Cirrhotic Patient

Harmouch, Maamoun; Hobeika, Mark J.

doi:10.1007/978-3-319-42792-8_4

Cited by 1 publication

(3 citation statements)

References 42 publications

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“…Cirrhotic patients exhibit a hyperdynamic status, with hypotension being regarded as a normal occurrence in these cases. The general volume overload associated with reduced intravascular volume in cirrhotic patients may warrant the use of invasive monitoring [ 60 , 95 ]. Lactic acidosis may occur not only in the setting of inadequate perfusion but also as a sign of liver decompensation [ 95 ].…”

Section: Perioperative Cognitive Dysfunction Management In Cirrhotic ...mentioning

confidence: 99%

“…The general volume overload associated with reduced intravascular volume in cirrhotic patients may warrant the use of invasive monitoring [ 60 , 95 ]. Lactic acidosis may occur not only in the setting of inadequate perfusion but also as a sign of liver decompensation [ 95 ]. Moreover, renal dysfunction following surgery in liver disease patients may be a result of either acute tubular necrosis or hepatorenal syndrome.…”

Section: Perioperative Cognitive Dysfunction Management In Cirrhotic ...mentioning

confidence: 99%

“…Regarding coagulation, INR has been suggested to be a sensitive test in assessing hepatic synthesis and a useful marker of hepatic decompensation. Targeting normal values and overcorrection of INR through the administration of FFP in an otherwise hemostatic patient is not required [ 60 , 95 ].…”

Section: Perioperative Cognitive Dysfunction Management In Cirrhotic ...mentioning

confidence: 99%

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The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature

et al. 2023

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Background and objectives: Postoperative cognitive dysfunction (POCD) represents a decreased cognitive performance in patients undergoing general anesthesia for major surgery. Since liver cirrhosis is associated with high mortality and morbidity rates, cirrhotic patients also assemble many risk factors for POCD. Therefore, preserving cognition after major surgery is a priority, especially in this group of patients. The purpose of this review is to summarize the current knowledge regarding the effectiveness of perioperative therapeutic strategies in terms of cognitive dysfunction reduction. Data Collection: Using medical search engines such as PubMed, Google Scholar, and Cochrane library, we analyzed articles on topics such as: POCD, perioperative management in patients with cirrhosis, hepatic encephalopathy, general anesthesia in patients with liver cirrhosis, depth of anesthesia, virtual reality in perioperative settings. We included 115 relevant original articles, reviews and meta-analyses, and other article types such as case reports, guidelines, editorials, and medical books. Results: According to the reviewed literature, the predictive capacity of the common clinical tools used to quantify cognitive dysfunction in cirrhotic settings is reduced in perioperative settings; however, novel neuropsychological tools could manage to better identify the subclinical forms of perioperative cognitive impairments in cirrhotic patients. Moreover, patients with preoperative hepatic encephalopathy could benefit from specific preventive strategies aimed to reduce the risk of further neurocognitive deterioration. Intraoperatively, the adequate monitoring of the anesthesia depth, appropriate anesthetics use, and an opioid-sparing technique have shown favorable results in terms of POCD. Early recovery after surgery (ERAS) protocols should be implemented in the postoperative setting. Other pharmacological strategies provided conflicting results in reducing POCD in cirrhotic patients. Conclusions: The perioperative management of the cognitive function of cirrhotic patients is challenging for anesthesia providers, with specific and targeted therapies for POCD still sparse. Therefore, the implementation of preventive strategies appears to remain the optimal attitude. Further research is needed for a better understanding of POCD, especially in cirrhotic patients.

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Section: Perioperative Cognitive Dysfunction Management In Cirrhotic ...mentioning

confidence: 99%

Section: Perioperative Cognitive Dysfunction Management In Cirrhotic ...mentioning

confidence: 99%

Section: Perioperative Cognitive Dysfunction Management In Cirrhotic ...mentioning

confidence: 99%

See 1 more Smart Citation

The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature

et al. 2023

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show abstract

Perioperative Management of the Cirrhotic Patient

Cited by 1 publication

References 42 publications

The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature

The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature

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