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Liver Surgery (Pain (Intrathecal morphine 300mcg
up to. 0.1mcg/kg, TAP…
Liver Surgery
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Intraoperative
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Clamping
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15mins then 5min break, maximum 90mins
Consent
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Increased risk
<4 MET, high right heart pressures (bleeding), pulm stenosis, severe lung disease, pre-op cholangitis, high Creatinine
inc risk of liver failure: Child-Pugh B or C, fatty liver, cirrhosis, thrombocytopaenia and hypersplenism, coags off
Indocyanine green retention rate of <14% at 15mins = safe limit for cirrhosis and max 60% being resected
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Scoring
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MELD (preTx)
BIC: Bilirubin, INR, Cr
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Functions
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Synthetic function
Clotting factors:
Coag factors, fibrinogen, protein C and S, antithrombin
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plasma proteins:
albumin, acute phase
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