الفهرس 
ANATOMY OF THE LIVEROnly 14 pages are availabe for public view
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Abstract
T
he discipline of liver transplantation has been developed over the past decades, and liver transplantation is now considered the gold standard for the treatment of patients with end-stage liver disease. Increasing success rates has led to broader indications and increased number of potential recipients.
Candidates for liver transplantation are subjected to thorough evaluation and assessment of all body systems to figure out all possible complications of end stage liver disease as hepatorenal syndrome, hepatopulmonary syndrome and hepatic encephalopathy. Liver function is also assessed through all available laboratory and radiological methods, finally they are subjected to routine preanesthetic evaluation.
Liver transplantation operation is conveniently divided into three phases: preanhepatic, anhepatic, and neohepatic phases. During the preanhepatic phase, a complete hepatectomy is performed. During the anhepatic phase, vascular anastomoses between the donor liver and the recipient’s vessels are constructed. During the neohepatic phase, the hepatic arterial and biliary anastomoses are constructed, and the wound is closed.
Anesthesia for liver transplantation is divided into the following phases:
1. Preinducion
During the preinduction phase, the final evaluation of the patient is performed and Last-minute laboratory results are reviewed. then premedication and close monitoring of the patient using standard monitors as pulse oximetry, ECG,capnography and thermometry in addition to ivasive monitoring as Central venous pressure monitoring, Pulmonary artery catheterization, Invasive blood pressure, Transesophageal echocardiography, Bispectral Index Monitoring. venovenous bypass may be performed during this phase.
2. Anesthetic Induction, Preparation for Surgery, and Maintenance
Rapid sequence induction with cricoid pressure using propofol 1 mg/kg and atracurium 0.5 mg/kg is done. Analgesia is achieved with short acting opioids as fentanyl. Maintenance is either by propofol infusion or inhalational agents as sevoflurane or isoflurane.
3. The Preanhepatic Phase
This phase is characterized by hemodynamic instability and coagulation defects. Hemodynamics is controlled either by activating venovenous bypass or rapid infusion of fluids with or without vasopressors as norepinephrine or vasopressin to maintain perfusion of vital organs. Coagulation is closely monitored with adequate correction of defects.
4. The Anhepatic Phase
Hemodynamics is usually stable but Serum electrolyte levels and acid–base balance are widely and rapidly swings. This includes Acidosis, hyperkalemia, hypocalcemia and hypoglycemia. Renal protection is a major concern.
5. The Neohepatic Phase
Graft reperfusion during this phase is associated with variety of hemodynamic disturbances defined as post-reperfusion syndrome manifested as decrease in mean arterial blood pressure. Acute clot lysis syndrome develops in this phase phase manifested clinically as diffuse bleeding from previously coagulated sites with elevation of the prothrombin time. Management includes the use of antifibrinolytic agents such as aprotinin, tranexamic acid, and ε- aminocaproic acid. Finally the patient is prepared for transfer to the ICU usually intubated.
In postoperative care intinial stabilization, fluid managment and electrolyte balance are of great concern, hemodynamically euvolemia is the goal.