Peri-operative Anesthetic Management in Liver Transplantation

The book covers all aspects of peri-operative anesthetic management of liver transplant patients. It provides a comprehensive coverage of the relevant history, surgeons’, hepatologists’, intensivists’ and pediatricians’ perspective of the disease, its pathogenesis, clinical presentation and indication for transplant. It discusses the practical aspects like fluid management and use of vasopressors. The book is divided into sections for a better and comprehensive delivery of information. Individual sections provide up to date information on the pre-operative issues and optimisation, intra-operative care and management and post-operative critical care issues and management of all transplant patients with special emphasis on recent advances. Separate sections cover ICU care of these patients in great detail and anesthetic management of pediatric liver transplant. The book includes anesthetic techniques involved in conducting multiorgan transplant. It discusses clinical approach to a patient with acute liver failure, brain death criteria and laws and organ donor management. It also presents newer techniques and methodologies adopted in the field of liver transplant. It includes ample illustrations, flowcharts, key points in each chapter, figures and photographs. The book contains chapters focusing on post-transplant patients presenting for non-transplant surgery.

 

The book fills the gap in the literature for a comprehensive guide for the anesthetist performing or pursuing liver transplant, students/trainees/examinees who have a keen interest in this field and doctors dealing with such patients in critical care, donor management, pursuing general anesthesia. It is also helpful for hepatologists, intensivists and surgeons associated with liver transplant.

2. Physiological role of liver & interpreting liver function tests

3. Pathophysiology of chronic liver disease

4. Pharmacokinetics & Pharmacodynamics of drugs in liver disease

5. Surgical anatomy of the liver

6. Non-transplant surgery for pre-transplant cirrhotic

7. Viral markers and their relevance in liver disease and transplantation

8. Indications and contraindications for liver transplantation

9. Disease Severity Scoring System in Chronic Liver Disease

10. Pre-operative assessment and optimization of liver transplant patients - Ascites, Hydrothorax

11. Pre-operative assessment and optimization of liver transplant patients - Cardiac issues in liver disease

12. Pre-operative assessment and optimization of liver transplant patients - Renal issues in liver disease

13. Pre-operative assessment and optimization - of liver transplant patients - Pulmonary issues in liver disease

14. Pre-operative assessment and optimization of liver transplant patients - Coagulation issues

15. Pre-operative assessment and optimization - of liver transplant patients – Nutrition

16. Intra-operative management of transplant recipient - An overview

17. Intra-operative monitoring - Hemodynamic monitoring in liver transplant surgery

18. Intra-operative monitoring - Coagulation monitoring in liver transplant surgery

19. Ischemia reperfusion injury

20. Intra-operative fluids in liver transplant surgery

21. Role of vasopressors in liver transplant surgery

22. Minimizing blood loss in recipient surgery - Antifibrinolytics/ Cell saver/ VVB/ Pringle and Surgical techniques

23. Venovenous bypass (VVB) in liver transplantation

24. Role of ECMO in Liver Transplant

25. Intra-operative complications and management - Air embolism, Surgical/ Medical haemorrhage, GI bleed, Intra-operative Oliguria, Refractory hypotension, Arrhythmias

26. Peri-operative assessment & management of live donor for donor hepatectomy

27. Brain Death and Organ Donation

28. Management of deceased donor for organ donation

29. Critical care management of acute liver failure

30. Assessment for transplanting acute liver failure patient

31. Bridging therapies in Acute Liver Failure (Hemodialysis and plasma exchange, Blood purification, Liver assist devices)

33. Anesthetic issue in the management of pediatic liver transplant

34. Challenges in pediatric liver transplant

35. Critical care management of pediatric liver transplant recipient

36. Combined liver kidney transplant

37. ABOI liver transplantation - Peri-operative consideration

38. Non-transplant surgery for post-transplant patient

39. Acute on chronic liver failure - An update

40. Anesthesia for interventional radiology in CLD & transplanted patient

41. Early post-operative care of transplant recipient

42. Assessment of early graft function and management of early graft failure

43. Post-operative renal dysfunction in recipient

44. Immunosuppression

45. Fast tracking in liver transplant recipient

46. Normothermic machine perfusion of liver for deceased donor transplant

47. Organ donation after cardiac death

Dr Vijay Vohra is Chairman, liver transplant, GI anesthesia and intensive care at Medanta The Medicity, Gurgaon, India. He has 37 years’ experience in anesthesiology after qualification. He headed the team that established liver transplant anaesthesia and critical care at two major centres in India (SGRH and Medanta). He has 5 years’ experience as Vice-Chairperson in policy making and running a large department of 40 anesthetists. Dr Vohra has imparted training in transplant anesthesia to visiting / fellow anesthetists and intensivists from 26 centres within India and abroad in the last 10 years. He has an experience of nearly 3000 liver transplants – among the highest anywhere. Dr Vohra is first in India to develop and introduce hemodynamic and coagulation monitoring protocol for bloodless liver transplant. He headed the anesthesia team that participated in almost all the firsts in liver transplantation in India. He has been a DNB teacher for 17 years. Dr Vohra has special expertise in anaesthesia in liver transplant, kidney transplant, GI surgery and vascular surgery. He is regularly invited as faculty to national and international conferences.

Dr Nikunj Gupta is a Diplomate in National Board (DNB) qualified anesthesiologist and has an experience of over 20 years in the specialty. He has been involved in the care of liver transplant patients for nearly 18 years. For the last 12 years, he been practicing peri-operative care of liver transplant patient at Medanta The Medicity, Gurgaon, India. He has been involved in the training of fellows admitted for liver transplant anesthesia at Medanta The Medicity.

Dr Annu Sarin Jolly has over twenty years of experience as a consultant anesthesiologist in leading multi-specialty hospitals of Delhi, India. Her area of interest is liver transplantation. She trained at the best centers of Delhi like Apollo, Sir Ganga Ram Hospital and Medanta, and had the privilege of working with pioneers in the field like Dr Soin and Dr Vijay Vohra, who have been her mentors. Currently, she is the clinical lead anesthesia at Narayana Health and conducts liver transplant anesthesia across its pan-India branches. She is also involved with pediatric transplants in NH SRCC Children’s Hospital, Mumbai.

Dr Annu has authored several national and international papers and contributed to a textbook on laparoscopic anesthesia before this. She has been actively involved in organizing seminars and teaching liver transplant fellows. She is also a DNB teacher and has several presentations to her credit.

Dr. Seema Bhalotra is a senior consultant, anaesthesia and critical care medicine. Have practiced anaesthesia in leading multispeciality hospitals like Ganga Ram hospital, New Delhi and Medanta, The Medicity, Gurugram. Have keen interest in Liver Transplant and gastrointestinal surgeries. Practiced liver transplant anaesthesia for 8 years in leading liver transplant center of India. Have been associated with teaching and training of DNB anaesthesia  and fellowship in liver transplant students. Have multiple national and international poster presentations and have contributed to chapters in anaesthesia related books.