Kundu Riddhi, Subramaniam Rajeshwari, Sardar Arijit
Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Anesth Essays Res. 2017 Oct-Dec;11(4):1101-1104. doi: 10.4103/aer.AER_94_17.
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.
尽管围手术期管理取得了进展，但由于多系统受累、术后肝失代偿风险高以及死亡率高，慢性肝病患者的手术操作对麻醉医生来说是一项重大挑战。我们描述了一名晚期肝病老年患者（终末期肝病模型评分16分）接受长时间腹部手术的麻醉管理。使用有创血流动力学监测、即时床旁生化和血液学监测，并及时纠正所有异常情况，促成了良好的结果。患者腹股沟肿胀原来是一个大的腹膜间皮瘤的延伸，需要做大的腹部切口并导致失血。通过双侧腹横肌平面阻滞提供镇痛，这有助于减少阿片类药物的使用并实现快速拔管。
