الفهرس 
ANATOMY OF THE LIVEROnly 14 pages are availabe for public view
 |  | from | 32 |  |  |
| | | from | 32 | | |
Abstract
Anesthesia and surgery in patients with problems related to the liver cause concern because of the central role of the liver in many of the body’s metabolic and synthetic functions .The incidence of patients with advanced disease scheduled for surgery is on the rise. Surgery in this patient poses a formidable challenge. Targeted interventions taken prior to surgery may help to prevent complications and to improve outcomes. The cornerstones of perioperative management in these patients are medical treatment of the complications of liver disease, including coagulopathy, ascites, encephalopathy, and malnutrition. Optimal preparation for surgery decreases the risk of complications or death following surgery.
The recent knowledge of the effects of anesthesia, improving surgical techniques, and use of better diagnostic tests will help reduce perioperative complications in these patients. Elective procedures should be postponed until the course of the disease can be determined. Adequate monitoring is also an important component of anesthetic planning .Both general and regional anesthesia techniques can decrease total hepatic blood flow. Episodes of perioperative hepatic ischemia can exacerbate preexisting liver disease. Therefore Maintain adequate hepatic perfusion and oxygen delivery is obligatory .Sepsis, coagulopathy, and emergency surgery correlate most with postoperative mortality. Therefore, a multidisciplinary approach to postoperative care is necessary.
These patients need to be observed closely for signs of Postoperative acute hepatic decompensation. Sedative and pain medications should be carefully titrated to prevent exacerbation of hepatic encephalopathy.
Optimal critical care treatment, particularly in the postoperative state (Correct coagulopathy, Minimize ascites to decrease risk of abdominal wall herniation, wound dehiscence, and improve ventilation, Address nutritional needs, and correct electrolyte abnormalities) decreases the incidence Postoperative Liver Dysfunction .