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Liver resection

Principles:

Keep dry – almost no fluid prior to resection

Then catch up

A-line, CVC, +/- swan sheath

Consider iVC compression by surgeons if hypotensive

Muscle relaxant (consider infusion)

Analgesia: spinal diamorphine, wound infusion catheter (2.5mg/ml levo-bupivicaine @ 10ml/hr). If using morphine PCA – caution (with liver impairment)

 

Anaesthesia for the obese patient

Beware of:

‘Apple’ fat distribution (central obesity)

Metabolic syndrome (3 of central obesity, hyper-tension, cholesterol, sugars, lipids)

 

Tips:

Pre-op: STOPBANG >5 = high risk of disordered breathing/OSA

AR: Consider test dose of 50mcg fentanyl pre-induction for sensitivity for opioids

RSI: No evidence

Drug dosing: Ideally use LBW. Practically IBW + few kg. For all drugs except suxamethonium and neostigmine

Position: Reverse trendelenburg with pillow under shoulders for tragus above sternum, rather than break in the bed

Extubation: consider NPA with lidocaine

Post-op: avoid ‘tying’ to the bed e.g. with a-line, infusions