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Obstructive jaundice and perioperative management

Authors :
Wei-Feng Yu
Long Wang
Source :
Acta Anaesthesiologica Taiwanica. 52(1):22-29
Publication Year :
2014
Publisher :
Elsevier BV, 2014.

Abstract

The causes of obstructive jaundice are varied, but it is most commonly due to choledocholithiasis; benign strictures of the biliary tract; pancreaticobiliary malignancies; and metastatic disease. Surgery in patients with obstructive jaundice is generally considered to be associated with a higher incidence of complications and mortality. Therefore, it poses a considerable challenge to the anesthesiologist, surgeons, and the intensive care team. However, appropriate preoperative evaluation and optimization can greatly contribute to a favorable outcome for perioperative jaundiced patients. This article outlines the association between obstructive jaundice and perioperative management, and reviews the clinical and experimental studies that have contributed to our knowledge of the underlying pathophysiologic mechanisms. Pathophysiology caused by obstructive jaundice involving coagulopathies, infection, renal dysfunction, and other adverse events should be fully assessed and reversed preoperatively. The depressed cardiovascular effects of obstructive jaundice are worth noticing because it has complicated mechanisms and needs to be further explored. Alterations of anesthesia-related drugs induced by obstructive jaundice are varied and clinicians should be aware of the possible need for a decrease in the anesthetic dose. Recommendations concerning the perioperative management of the patients with obstructive jaundice including preoperative biliary drainage, anti-infection, nutrition support, coagulation reversal, cardiovascular evaluation, perioperative fluid therapy, and hemodynamic optimization should be taken.

Details

ISSN :
18754597
Volume :
52
Issue :
1
Database :
OpenAIRE
Journal :
Acta Anaesthesiologica Taiwanica
Accession number :
edsair.doi.dedup.....8efb40c8cb441493099a913143f8c0fa
Full Text :
https://doi.org/10.1016/j.aat.2014.03.002