الفهرس 
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Abstract
Patients with liver disease and portal hypertension usually as a result of advanced fibrosis or cirrhosis, are at increased risk of complications when undergoing surgery.
Portal hypertension is generally defined when any 2 of the following 3 criteria are met: splenomegaly, ascites or bleeding esophageal varices.
The pharmacokinetics and pharmacodynamics of anaesthetic drugs are significantly altered in liver disease, Presence of liver failure mandates lowering drug dosages to minimal effective level.
The choice of general anesthesia for these patients rely on safe agents (short acting fast emergence), most patients considered as having a full stomach because of marked abdominal distention or recent upper gastrointestinal bleeding, so general anesthesia induced via a rapid sequence induction via short acting agents with rapid onset and rapid offset according to body weight of the patient and hemodynamics.
OPiOID: Like fentanyl 1_2µg/kg
Propofol 1- 2 mg/kg is a potent intravenous hypnotic drug
Rocuronium 0.6-1.2mg /kg is a non-depolarizing neuromuscular blocker also known as competitive muscle relaxants, has the distinct advantage of being fast-acting and reversible.
Maintain general anesthesia via inhalational anesthesia like isoflurane or sevoflurane.
Liver blood flow is affected by a number of factors during anaesthesia and surgery. These include: intermittent positive pressure ventilation, blood gas changes (in particular, pCO2), sympathetic nervous system activity, splanchnic reflexes, changes in cardiac output, gastrointestinal and hepatic disease, direct effects of anaesthetic and other drugs used during anaesthesia, and surgical trauma, a This latter may be the most important factor, particularly during abdominal surgery.
The higher incidence of complications in abdominal surgery is probably explained by hepatic ischaemia and an increased risk of intraoperative bleeding in the presence of portal hypertension especially in patients with previous abdominal surgery and adhesions.
Following anaesthesia and surgery, liver dysfunction is usually first manifested by the appearance of jaundice. A rise in bilirubin alone is fairly common after major surgery. The usual causes are: (1) blood transfusion, (2) tissue injury, and (3) infection.In addition, pre-existing liver disease may deteriorate as a result of these factors, Elevated serum enzymes (transaminases) also occur commonly after major surgery and are probably due to the tissue damage involved in the surgical procedure. Recently, attention has been drawn to the role of hypoxia in postoperative liver dysfunction. It has been suggested that many of these minor changes may be due to hepatic hypoxia occurring either during anaesthesia or in the immediate postoperative period.
The aim of the study is to assess the changes in liver functions postoperatively in patients with portal hypertension undergoing abdominal or pelvic surgeries, to assess intra operative complications in patients with portal hypertension undergoing general anesthesia, for abdominal or pelvic surgeries.
The type of this study is prospective Observational Study, conducted at Ain Shams University Specialized Hospital on 40 patients in 6 months duration.
In this study, we compared changes in liver functions postoperative in patients with portal hypertension undergoing pelvic surgery or abdominal surgery and there were highly significant difference between pre operative and post operative labs as postoperative Hb, Plts level decreased while INR, liver enzymes, bilirubin level increased than preoperative.
There was significant difference between pelvic surgery and abdominal surgery of the studied patients regarding intra-operative blood loss as amount of blood loss intraoperative increased in abdominal surgery more than pelvic surgery.
In this study, we compared between pelvic surgery and abdominal surgery regarding laboratory data post operative, and there were highly significant difference in labs postoperative between them as liver enzymes increased, Hb, Plts levels decreased in abdominal surgery more than pelvic surgery.
In our study we compared between child B, child C classification patients there was highly significant difference between them regarding total time of surgery as time of surgery increased in child C patients more than child B patients, there were highly significant difference between them postoperative regarding hepatic encephalopathy, Bilirubin as they affected more in child C patients and there were highly significant difference between them regarding blood products transfusion as child C patients received more amounts of PRBCS, FFP, Plts transfusion than child B patients.