PERI-OPERATIVE MANAGEMENT OF LIVER CIRRHOSIS WITH HEPATO-RENAL SYNDROME: CASE SERIES

Ramneek Kaur; Nisarg Patel

Volume : VII, Issue : XI, November - 2018

PERI-OPERATIVE MANAGEMENT OF LIVER CIRRHOSIS WITH HEPATO-RENAL SYNDROME: CASE SERIES

Ramneek Kaur, Nisarg Patel

Abstract :

INTRODUCTION:

Liver Transplant is a highly challenging and demanding procedure for the anaesthesiologist.

The surgery is usually lengthy and complicated with critical patient condition. HEPATORENAL SYNDROME is a serious complication of Liver Cirrhosis with critically poor

prognosis.Pathophysiological hallmark is Renal Vasoconstriction because of complex changes

In Splanchnic vasoconstriction and general circulation.The definite treatment is Liver Transplant.

METHODS:

5 cases of Chronic Liver Cirrhosis with Hepatorenal Syndrome were studied retrospectively.

Three patients had NASH -related Cirrhosis, two had Alcoholic Liver disease.Patients

were optimised preoperatively either by vasoconstrictor therapy or Renal replacement therapy.All were induced using the same Anaesthetic agents and invasive monitoring of BP, CVP and PAP was employed for all.Intraoperative intravascular volume was maintained based on hourly input-output data.Coagulation control was guided by intra-operative TEG.

RESULTS:

Three patients had intra-op fluid intake more than output, renal function was regained earliest in the one with min input-output difference.Two patients had intra-op output more than input, renal function was regained almost immediately. patients who received intra-op continuous renal replacement therapy; regained renal function last .

CONCLUSION:

Most cases of renal dysfunction in cirrhosis are functional.Vasocontrictor therapy, renal replacement therapy improve short-term outcome and buy time for

Liver transplant.A thorough assessment of cardiovascular,renal,hematological,fluid and electrolyte status of the patient and a good knowledge of the pathophysiology of HRS and its anaesthetic implications are mandatory for successful management.