Anaesthesia for hepatobiliary surgery is complicated by both the complex nature of the surgery and by the underlying condition of the patient that may have contributed to the need for surgery. A liver resection on an otherwise fit and healthy individual with an isolated adenoma is very different to that on a cirrhotic patient. Therefore it is important not only to optimise these patients prior to surgery, but also to take into account the potential risk of post-operative liver dysfunction as a consequence of anaesthesia or surgery.

Pre-operative factors

Assessment of the patient

As with any field of medicine, a thorough history and examination is important. Patients undergoing any type of surgery have to be individually assessed, taking into account their co-morbidities. Pre-existing liver dysfunction needs not only greater assessment but also considerable multi-disciplinary input to ensure a favourable outcome. This group of patients are at significant risk of multi-organ failure and post-operative liver failure. The advent of pre-operative assessment clinics which are nurse-led with anaesthetic support has meant that potential problems can be identified and dealt with prior to day of surgery admission. All patients with chronic liver disease or undergoing a hepatectomy should have the standard pre-operative work-up including full blood count, urea and electrolytes, glucose, liver function tests and prothrombin time performed. Patients with portal hypertension undergoing hepatic resection should have their portal pressures measured (see below).