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The Patient with End-Stage Liver Disease

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Book cover Anesthesia in High-Risk Patients

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Abstract

Cirrhosis, the end-stage of liver diseases, is an increasing cause of morbidity and mortality [1]. The decompensation of the liver function is a key event during the natural history of this disease as it substantially worsen patient prognosis. Surgery and anesthesia are well-known cause of cirrhosis decompensation that may lead, at worst, to “acute on chronic liver failure” if it is associated with organ failures. In this context, it is not surprising that the reported in-hospital mortality after various non-transplant surgical procedures ranges from as much as 8.3–25% in selected cirrhotic patients compared to 1.1% in non-cirrhotic patients [2, 3]. In a recent 7-day cohort study including 46,539 patients that underwent surgery in 498 hospitals in 28 European countries, liver cirrhosis was associated with an increase of postoperative mortality by more than threefold [4]. Despite this poor outcome, improvements in the medical management and life expectancy have increased the eligibility of these patients to surgery. For these reasons, this chapter will (1) review pathophysiological modifications induced by cirrhosis in order to improve their perioperative management, (2) summarize recent data on surgical risk assessment in these patients, and (3) provide therapeutic approaches for perioperative optimization in this unique group of surgical candidates.

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, APHP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, F-75018, Paris, France

    Emmanuel Weiss & Catherine Paugam-Burtz

  2. Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France

    Emmanuel Weiss & Catherine Paugam-Burtz

  3. Inserm UMR_S1149, Center for Research on Inflammation, Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France

    Emmanuel Weiss & Catherine Paugam-Burtz

Authors
  1. Emmanuel Weiss
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  2. Catherine Paugam-Burtz
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Correspondence to Catherine Paugam-Burtz .

Editor information

Editors and Affiliations

  1. Department of Anaesthesiology and Critical Care Medicine, Louis Pradel Hosp, Hospices Civils Lyon, Lyon, Rhône, France

    Jean-Luc Fellahi

  2. Service d'Anesthésie-Réanimation, Hôpital Nord, Marseille cedex 20, France

    Marc Leone

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Weiss, E., Paugam-Burtz, C. (2018). The Patient with End-Stage Liver Disease. In: Fellahi, JL., Leone, M. (eds) Anesthesia in High-Risk Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-60804-4_11

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  • DOI: https://doi.org/10.1007/978-3-319-60804-4_11

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  • Print ISBN: 978-3-319-60803-7

  • Online ISBN: 978-3-319-60804-4

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