Passage of nasogastric tubes should be
done with care in patients with esophageal varices. If coagulation function
is compromised, particular care should be paid to insertion of invasive
lines and intubation. Regional techniques are worth considering if there is
no coagulopathy. Otherwise, intubation and controlled ventilation should be
employed, especially in patients with ascites or pleural effusion, and to
minimize the risk for pulmonary aspiration. Patients with significant
hepatic impairment and hyperbilirubinemia (>180 mmol/L) are at higher risk
for renal failure; these patients should be adequately hydrated (guided by
central venous pressure if necessary), and maintenance of diuresis before,
during, and after operation with fluid loading, mannitol, or furosemide.
Partial hepatectomy is usually associated with massive blood loss, with
subsequent massive blood transfusion and its attendant complications. Close
monitoring of blood loss is necessary, as is the need to maintain adequate
venous access, normothermia, electrolytes, and acid-base balance.