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Der Anaesthesist

, Volume 60, Issue 2, pp 103–117 | Cite as

Perioperatives anästhesiologisches Management bei ausgedehnten Leberteilresektionen

Pathophysiologie der Lebererkrankungen und funktionelle Zeichen des Leberversagens
  • S. Herz
  • G. Puhl
  • C. Spies
  • D. Jörres
  • P. Neuhaus
  • C. von HeymannEmail author
Leitthema

Zusammenfassung

Die Bedeutung der Leberteilresektion als potenziell kurative Therapie bei Tumoren der Leber hat in den letzten Jahrzehnten zugenommen. Verantwortlich hierfür sind einerseits eine gesunkene perioperative Letalität und Morbidität durch Fortschritte im chirurgischen und anästhesiologischen Management sowie andererseits die gestiegene Inzidenz von hepatozellulären Karzinomen. Heute wird die Leberteilresektion in Zentren regelhaft und sicher durchgeführt. Dieser Beitrag beschreibt zunächst die pathophysiologischen Veränderungen, die bei einer Leberinsuffizienz und nach ausgedehnten Leberteilresektionen auftreten können, und gibt Empfehlungen zur präoperativen Abklärung der Patienten. Im zweiten Teil wird das perioperative anästhesiologische Management dargestellt, unter Berücksichtigung von Besonderheiten der Narkoseführung, des Volumenmanagements, der Techniken zur Verringerung des Blutverlusts, der perioperativen Analgesie und der postoperativen Intensivtherapie.

Schlüsselworte

Leberinsuffizienz Zirrhose Kolorektale Neoplasien Perioperative Versorgung Hepatektomie 

Perioperative anesthesia management of extended partial liver resection

Pathophysiology of hepatic diseases and functional signs of hepatic failure

Abstract

The importance of partial liver resection as a therapeutic option to cure hepatic tumors has increased over the last decades. This has been influenced on the one hand by advances in surgical and anesthetic management resulting in a reduced mortality after surgery and on the other hand by an increased incidence of hepatocellular carcinoma. Nowadays, partial resection of the liver is performed safely and as a routine operation in specialized centers. This article describes the pathophysiological changes secondary to liver failure and assesses the perioperative management of patients undergoing partial or extended liver resection. It looks in detail at the preoperative assessment, the intraoperative anesthetic management including fluid management and techniques to reduce blood loss as well as postoperative analgesia and intensive care therapy.

Keywords

Hepatic failure Cirrhosis Colorectal neoplasms Perioperative care Hepatectomy 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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© Springer-Verlag 2011

Authors and Affiliations

  • S. Herz
    • 1
  • G. Puhl
    • 2
  • C. Spies
    • 1
  • D. Jörres
    • 1
  • P. Neuhaus
    • 2
  • C. von Heymann
    • 1
    Email author
  1. 1.Klinik für Anästhesiologie mit Schwerpunkt operative IntensivmedizinCharité – Universitätsmedizin Berlin,Campus Virchow-Klinikum und Charité MitteBerlinDeutschland
  2. 2.Klinik für Allgemein-, Visceral- und TransplantationschirurgieCharité- Universitätsmedizin Berlin, Campus Virchow-Klinikum und Charité MitteBerlinDeutschland

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