[HSF] Operating on Liver Cirrhotics

[prasannasimha]

Drain as the ascites causes renal vein compression and falling urine 
output. Protein management becomes an issue .The oncotic pressure may 
have to be raised. (If TR settles by repair then usually things become 
better and the ascites does not re accumulate).
One regimen is the one that Nasser posted (Yeast - Honey) regimen as a 
hepatoprotective agent.
Prasanna
Ani Anyanwu wrote:
> How do members deal with the massive ascites often associated with this condition? Ignore or drain (and if you drain, when and how much?)?
>
> Claudia raised an important issue of nutrition - how do members address this?
>
> Thank you
>
> Ani
>
> ----- Original Message -----
> From: A
> Sent: Sunday, July 01, 2007 2:27 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: RE: [HSF] Operating on Liver Cirrhotics
>
> One of the dreaded complications is bleeding that can be so difficult to
> manage. Over the years I have operated on a handful of such cases and they
> have done well. I give these patients three doses of IV vitamin K1 given by
> an MD over a period of ten minutes by the clock. The protocol takes three
> days to complete. This is beside taking meticulous care when opening and
> closing etc and the routine preop care.
> I hope that this helps.
>
> Ahmed
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Saturday, June 30, 2007 8:28 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Operating on Liver Cirrhotics
>
> Ani vasodilator perfusion is more based on theoretical construct of  
> decreased hepatic flow with CPB. It is like TRT its use has to be  
> ultimately be proved.It has been shown that nitrate infusions increases  
> hepatic flow during CPB. Delivering targetted would be better hopefully.
> Prasanna
> Ani Anyanwu wrote:
>   
>> I would be keen to know approaches members use to reduce the morbidity or
>>     
> mortality associated with cardiac surgery in patients with liver cirrhosis.
>
>   
>> We have an active liver transplant program and few times a year i have to
>>     
> operate on patients requiring liver transplant who have co-existing cardiac
> problems. These patients seem so unpredictable and mortality has been high
> such that on occasion some surgeons have done the (cardiac) procedure in
> combination with the liver transplant.
>   
>> I would be grateful for any tips on dealing with this difficult group.
>>     
> Prassana I know has a regime of hepatic infusion of venodilators - is their
> logic or data to back this and do others have experience of this technique?
> Do people give Factor VII pre-emptively?
>   
>> Thanks
>> Ani
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