Article information
SUMMARY
Fulminant hepatic failure (FHF) is defined by sudden onset of encephalopathy, coagulopathy and jaundice in an otherwise normal individual. Fulminant hepatic failure results in progressive multi-organ failure with a dramatic impact in the brain. Severe cerebral edema is a frequent finding that ultimately lead to intracranial hypertension and death The management of patients with FHF is aimed mainly in prevent or reversing increased intracranial pressure associated with support treatment for other failing organs. The definitive treatment for patients with FHF is liver transplantation. This article aims to present a practical approach to anesthesia care and intraoperative management of patients with FHF.
RESUMEN
La falla hepática fulminante (FHF) es definida como el comienzo súbito de encefalopatía, coagulopatía e ictericia en un individuo que se encontraba en condiciones normales de salud. La falla hepática fulminante termina en un deterioro progresivo de múltiples órganos con un impacto dramático en el cerebro.
El edema cerebral severo es un hallazgo frecuente que, finalmente, conlleva a hipertensión intracraneal y a la muerte. El manejo de pacientes con FHF apunta principalmente a prevenir o reversar el incremento de la presión intracraneal, asociada con el tratamiento de soporte para la falla de otros órganos. El tratamiento definitivo para pacientes con FHF es el trasplante de hígado. Este artículo tiene como objetivo presentar una aproximación práctica al cuidado anestésico e intraoperativo para el manejo de pacientes con FHF.
Key Words:
Fulminant Hepatic failure
Liver failure
Intracranial Hypertension
Liver Transplantation
Anesthesia (Source: MeSH, NLM)
Palabras Clave:
Fallo hepático agudo
insuficiencia hepática
hipertensión intracraneal
trasplante de higado
anestesia (Fuente: DeCS, BIREME)
Full text is only aviable in PDF
REFERENCIAS
[1.]
J.D. Punch.
Bridges to transplantation.
Anesthesiol Clin North America, 22 (2004 Dec), pp. 863-869
[2.]
J. Vaquero, C. Chung, M.E. Cahill, A.T. Blei.
Pathogenesis of hepatic encephalopathy in acute liver failure.
Semin Liver Dis, 23 (2003 Aug), pp. 259-269
[3.]
J.P. Donovan, D.F. Schafer, B.W. Shaw Jr., M.F. Sorrell.
Cerebral oedema and increased intracranial pressure in chronic liver disease.
Lancet, 351 (1998 Mar 7), pp. 719-721
[4.]
D. Haussinger, G. Kircheis, R. Fischer, F. Schliess, S. vom Dahl.
Hepatic encephalopathy in chronic liver disease: a clinical manifestation of astrocyte swelling and low-grade cerebral edema?.
J Hepatol, 32 (2000 Jun), pp. 1035-1038
[5.]
A. Bacher, M. Zimpfer.
Hot topics in liver intensive care.
Transplant Proc, 40 (2008 May), pp. 1179-1182
[6.]
D. Debray, N. Yousef, P. Durand.
New management options for end-stage chronic liver disease and acute liver failure: potential for pediatric patients.
Paediatr Drugs, 8 (2006), pp. 1-13
[7.]
M.K. Han, R. Hyzy.
Advances in critical care management of hepatic failure and insufficiency.
Crit Care Med, 34 (2006 Sep), pp. S225-S231
[8.]
B. Ekser, B. Gridelli, A.J. Tector, D.K. Cooper.
Pig liver xenotransplantation as a bridge to allotransplantation: which patients might benefit?.
Transplantation, 88 (2009 Nov 15), pp. 1041-1049
[9.]
F.H. Galvao, E. Pompeu, E.S. de Mello, A. da Costa Lino Costa, E. Mory, R,.M. Dos Santos.
Experimental multivisceral xenotransplantation.
Xenotransplantation, 15 (2008 May), pp. 184-190
[10.]
S.R. Mitzner, J. Stange, S. Klammt, S. Koball, H. Hickstein, E.C. Reisinger.
Albumin dialysis MARS: knowledge from 10 years of clinical investigation.
ASAIO J, 55 (2009 Sep-Oct), pp. 498-502
[11.]
P.S. Mushlin, S. Gelman.
Anesthesia and the Liver.
Clinical Anesthesia, 4a edição, pp. 1067-1101
[12.]
R.H. Steadman.
Anesthesia for liver transplant surgery.
Anesthesiol Clin North America, 22 (2004 Dec), pp. 687-711
[13.]
M.J. Krowka, M.K. Porayko, D.J. Plevak, S.C. Pappas, J.L. Steers, R.A. Krom.
Hepatopulmonary syndrome with progressive hypoxemia as an indication for liver transplantation: case reports and literature review.
Mayo Clin Proc, 72 (1997 Jan), pp. 44-53
[14.]
W.K. Lai, N. Murphy.
Management of acute liver failure.
Continuing Education in Anaesthesia, Critical Care & Pain, 4 (2004), pp. 40-43
[15.]
Y. Kang, J.H. Lewis, A. Navalgund, M.W. Russell, F.A. Bontempo, L.S. Niren.
Epsilon-aminocaproic acid for treatment of fibrinolysis during liver transplantation.
Anesthesiology, 66 (1987 Jun), pp. 766-773
[16.]
C.T. Petrovich.
An approach to the patient who may have a bleeding disorder.
ASA Refresher Courses in Anesthesiology, 32 (2004), pp. 1-5
[17.]
S. Moller, F. Bendtsen, J.H. Henriksen.
Pathophysiological basis of pharmacotherapy in the hepatorenal syndrome.
Scand J Gastroenterol, 40 (2005), pp. 491-500
[18.]
S. Iwatsuki, M.M. Popovtzer, J.L. Corman, M. Ishikawa, C.W. Putnam, F.H. Katz.
Recovery from “hepatorenal syndrome” after orthotopic liver transplantation.
N Engl J Med, 289 (1973 Nov 29), pp. 1155-1159
[19.]
J.O. Clemmesen, F.S. Larsen, J. Kondrup, B.A. Hansen, P. Ott.
Cerebral herniation in patients with acute liver failure is correlated with arterial ammonia concentration.
Hepatology, 29 (1999 Mar), pp. 648-653
[20.]
K.K. Mukherjee, R. Chhabra, V.K. Khosla.
Raised intracranial pressure in hepatic encephalopathy.
Indian J Gastroenterol, 22 (2003 Dec), pp. S62-S65
[21.]
J.A. Rocha Filho, J.P.S. Rocha, R.S. Nani.
Anestesia para transplante hepático.
Tratado de Anestesiologia, pp. 1899-1909
[22.]
R. Jalan.
Intracranial hypertension in acute liver failure: pathophysiological basis of rational management.
Semin Liver Dis, 23 (2003 Aug), pp. 271-282
[23.]
A. Ellis, J. Wendon.
Circulatory, respiratory, cerebral, and renal derangements in acute liver failure: pathophysiology and management.
Semin Liver Dis, 16 (1996 Nov), pp. 379-388
[24.]
J. Wendon, W. Lee.
Encephalopathy and cerebral edema in the setting of acute liver failure: pathogenesis and management.
Neurocrit Care, 9 (2008), pp. 97-102
[25.]
A.T. Rabadan, N. Spaho, D. Hernandez, A. Gadano, E. de Santibanes.
Intraparenchymal intracranial pressure monitoring in patients with acute liver failure.
Arq Neuropsiquiatr, 66 (2008 Jun), pp. 374-377
[26.]
O. Detry, N. Arkadopoulos, P. Ting, E. Kahaku, J. Margulies, W. Arnaout.
Intracranial pressure during liver transplantation for fulminant hepatic failure.
Transplantation, 67 (1999 Mar 15), pp. 767-770
[27.]
R. Jalan, N.A. Davies, S.W. Damink.
Hypothermia for the management of intracranial hypertension in acute liver failure.
Metab Brain Dis, 17 (2002 Dec), pp. 437-444
[28.]
J.A. Filho, M.A. Machado, R.S. Nani, J.P. Rocha, E.R. Figueira, T. Bacchella.
Hypertonic saline solution increases cerebral perfusion pressure during clinical orthotopic liver transplantation for fulminant hepatic failure: preliminary results.
Clinics (Sao Paulo), 61 (2006 Jun), pp. 231-238
[29.]
R. Jalan, S.W. Olde Damink, N.E. Deutz, N.A. Davies, O.J. Garden, K.K. Madhavan.
Moderate hypothermia prevents cerebral hyperemia and increase in intracranial pressure in patients undergoing liver transplantation for acute liver failure.
Transplantation, 75 (2003 Jun 27), pp. 2034-2039
[30.]
D. Dmello, S. Cruz-Flores, G.M. Matuschak.
Moderate hypothermia with intracranial pressure monitoring as a therapeutic paradigm for the management of acute liver failure: a systematic review.
Intensive Care Med, (2009 Oct 22),
[31.]
A.R. Mueller, K.P. Platz, P. Krause, A. Kahl, N. Rayes, M. Glanemann.
Perioperative factors influencing patient outcome after liver transplantation.
Transpl Int, 13 (2000), pp. S158-S161
[32.]
E. Mor, L. Jennings, T.A. Gonwa, M.J. Holman, J. Gibbs, H. Solomon.
The impact of operative bleeding on outcome in transplantation of the liver.
Surg Gynecol Obstet, 176 (1993 Mar), pp. 219-227
[33.]
V. Srinivasa, L.I. Gilbertson, K. Bhavani-Shankar.
Thromboelastography: where is it and where is it heading?.
Int Anesthesiol Clin, 39 (2001 Winter), pp. 35-49
[34.]
V.L. Scott, A.M. De Wolf, Y. Kang, B.T. Altura, M.A. Virji, D.R. Cook.
Ionized hypomagnesemia in patients undergoing orthotopic liver transplantation: a complication of citrate intoxication.
Liver Transpl Surg, 2 (1996 Sep), pp. 343-347
[35.]
G.B. Hammer, E.J. Krane.
Anaesthesia for liver transplantation in children.
Paediatr Anaesth, 11 (2001 Jan), pp. 3-18
[36.]
S.D. Kelley, C.B. Cauldwell.
Anesthesia for transplantation.
Pediatric Anesthesia, 2a edição,
[37.]
Y.G. Kang, J.A. Freeman, S. Aggarwal, A.M. DeWolf.
Hemodynamic instability during liver transplantation.
Transplant Proc, 21 (1989 Jun), pp. 3489-3492
[38.]
J.A. Estrin, K.G. Belani, N.L. Ascher, D. Lura, W. Payne, J.S. Najarian.
Hemodynamic changes on clamping and unclamping of major vessels during liver transplantation.
Transplant Proc, 21 (1989 Jun), pp. 3500-3505
[39.]
S. Aggarwal, Y. Kang, J.A. Freeman, F.L. Fortunato, M.R. Pinsky.
Postreperfusion syndrome: cardiovascular collapse following hepatic reperfusion during liver transplantation.
Transplant Proc, 19 (1987 Aug), pp. 54-55
[40.]
G. Dec, N. Kondo, F. ML, D. J, C. AB, S. MJ.
Cardiovascular complications following liver transplantation.
Clinical Transplantation. 1995, 9 (1995, DEC), pp. 463-471
[41.]
S. Blanot, M.C. Gillon, I. Lopez, C. Ecoffey.
Circulating endotoxins and postreperfusion syndrome during orthotopic liver transplantation.
Transplantation, 60 (1995 Jul 15), pp. 103-106
[42.]
W.N. Goode HF, P.D. Howdle.
Reperfusion injury, antioxidants and hemodynamics during orthotopic liver transplantation.
Hepatology 1994, 19 (1994), pp. 354
[43.]
S. Aggarwal, Y. Kang, J.A. Freeman, F.L. Fortunato Jr., M.R. Pinsky.
Postreperfusion syndrome: hypotension after reperfusion of the transplanted liver.
J Crit Care, 8 (1993 Sep), pp. 154-160
[44.]
T. Ayoub, K. Ahmed.
Liver transplant anesthesia: an update.
Curr Opin Organ Transplant, 8 (2003), pp. 252-257
[45.]
A.K. Chui, L. Shi, K. Tanaka, A.R. Rao, L.S. Wang, M. Bookallil.
Postreperfusion syndrome in orthotopic liver transplantation.
Transplant Proc, 32 (2000 Nov), pp. 2116-2117
[46.]
M. Nakasuji, M.J. Bookallil.
Pathophysiological mechanisms of postrevascularization hyperkalemia in orthotopic liver transplantation.
Anesth Analg, 91 (2000 Dec), pp. 1351-1355
[47.]
M. Braunfeld.
Anesthesia for liver transplantation.
ASA Refresher Courses in Anesthesiology, 29 (2001), pp. 83-96
[48.]
J.W. Chapin, K.R. Peters, J. Winslow, G.L. Becker, H. Skinner.
Circulating heparin during liver transplantation.
Transplant Proc, 25 (1993 Apr), pp. 1803
[49.]
C. Legnani, G. Palareti, G. Rodorigo, G. Gozzetti, A. Mazziotti, G. Martinelli.
Protease activities, as well as plasminogen activators, contribute to the “lytic” state during orthotopic liver transplantation.
Transplantation, 56 (1993 Sep), pp. 568-572
[50.]
R.J. Porte, F.A. Bontempo, E.A. Knot, J.H. Lewis, Y.G. Kang, T.E. Starzl.
Tissue-type-plasminogen-activatorassociated fibrinolysis in orthotopic liver transplantation.
Transplant Proc, 21 (1989 Jun), pp. 3542
[51.]
A. De Gasperi, A. Corti, E. Mazza, M. Prosperi, O. Amici, L. Bettinelli.
Acute liver failure: managing coagulopathy and the bleeding diathesis.
Transplant Proc, 41 (2009 May), pp. 1256-1259
Copyright © 2009. Revista Colombiana de Anestesiología
Article options