Key result
Careful anesthetic management, including invasive monitoring, point-of-care testing, and transversus abdominis plane blocks, resulted in the successful perioperative outcome of an elderly patient with advanced liver disease undergoing prolonged abdominal surgery.
Case Report (n=1)
No
Invasive monitoring and regional anesthesia techniques like transversus abdominis plane blocks can facilitate safe anesthetic management and rapid extubation in patients with advanced liver disease undergoing major surgery.
May support individualized care in advanced liver disease; leaves open generalizability and need for prospective trials.
In spite of advances in perioperative management, operative procedures in patients with chronic liver disease pose a significant challenge for the anesthesiologist due to multisystem involvement, high risk of postoperative hepatic decompensation, and mortality. We describe the anesthetic management of an elderly patient with advanced liver disease (model for end-stage liver disease 16) for prolonged abdominal surgery. The use of invasive hemodynamic monitoring, point-of-care biochemical, and hematological surveillance coupled with prompt correction of all abnormalities was responsible for good outcome. The patient's inguinal swellings turned out to be extensions of a large peritoneal mesothelioma, necessitating a large abdominal incision and blood loss. Analgesia was provided by bilateral transversus abdominis plane blocks, which helped to reduce opioid use and rapid extubation.
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Subramaniam et al. (2017) conducted a case report in Advanced liver disease (MELD 16) and peritoneal mesothelioma (n=1). Anesthetic management (invasive monitoring, point-of-care testing, TAP blocks) was evaluated on Perioperative outcome and survival. Careful anesthetic management, including invasive monitoring, point-of-care testing, and transversus abdominis plane blocks, resulted in the successful perioperative outcome of an elderly patient with advanced liver disease undergoing prolonged abdominal surgery.
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