Liver
Last updated: February 9, 2026
- Airway
- Oral ETT. Nasal trumpet (lube, Afrin) for NGT.
- Induction
- Standard
- Maintenance
- Gas/paralytic
- Emergence
- +/- extubate or up to ICU on propofol
- Antibiotics
- Ampicillin/sulbactam 20 mL x2, methylprednisolone (500 mg in one stick)
- Position
- 0. Arms out. Underbody Allon water warmer +/- upper body air warmer. **CRRT:** **TEE:**
- Access
- PIV x2-3 large (14 or 16), Triple Set \[Art Line, CVC MAC with PAC and CCO box calibrated\], +/- bypass cannula, +/- TEE machine and probe, +/- CRRT line
- Pressors
- vasopressin 20 mL, dilute epinephrine x3, code epinephrine x3, calcium chloride x3, nicardipine x1
- Sugars
- Dextrose 50 mL x2, insulin x1
- Misc
- Glycopyrrolate, succinylcholine, albumin 5% x4-8.
- Alaris
- Epi/NE/phenylephrine/(+/-) vaso || propofol/0/(+/-) insulin/runner
- Fluids
- Warm line x2 (RBC, FFP), Y set x1 (PLT). One standard fluid line for bypass cannula.
- Blood
- 8RBC/8FFP/2PLT
- Pre-anhepatic (Dissection)
- Dissection + hepatectomy. Frequent ABG. Resus with crystalloid. Can give 1 PLT if thrombocytopenic to start. 500 mg methylprednisolone after hepatectomy complete.
- Anhepatic
- Surgeon will place venous drainage cannula in femoral vein, go on VVB. Inflow femoral, outflow through 16Fr venous return cannula. Allows surgeon to clamp IVC above and below native liver. Treat hyperkalemia aggressively, consider 2 PLT when coming off VVB.
- Neohepatic (Reperfusion)
- Get ready to support the RV.
- Post-op
- JP1, 2, 3 are L to R. JP2 matters most since it is at biliary anastomosis (which receives all O2 from hepatic artery). Enzymes rise and fall in order of: LDH, AST, ALT, TB, GGT/AP.