Patienten mit Leberzirrhose – Perioperatives Management

Die zunehmende Inzidenz von Patienten mit Leberinsuffizienz führt auch zu einer Zunahme von Patienten mit perioperativem Acute-on-chronic-liver-failure mit oftmals deletärem Ausgang. Eine Vielzahl von kleinen Optimierungsmöglichkeiten kann entscheidend zum Outcome dieser Patienten beitragen. Dieser Artikel soll eine kurze Übersicht geben, wie Risikopatienten identifiziert werden können, mit welchen Beeinträchtigungen welcher Organsysteme wir perioperativ kämpfen müssen und soll Überlegungen zur Vermeidung intra- und postoperativer Komplikationen anregen.

Due to the increased incidence of patients with hepatocellular dysfunction, patients suffering from acute-on-chronic-liver-failure are a common occurrence in perioperative anesthesia management. A large variety of small therapeutic options, however, can contribute to improve patients' postoperative outcome. The aim of this review article is to show different approaches to identify risk patients, outlines the pathophysiological changes in extrahepatic organs secondary to liver failure, and provides strategies to limit intra- and postoperative complications.

Key words

hepatocellular dysfunction - acute-on-chronic-liver-failure - perioperative anesthesia management

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