An overview of unresolved issues in the perioperative management of liver transplant patients.

Over the past decade, the field of solid organ transplantation has undergone significant changes, with some of the most notable advancements occurring in liver transplantation. Recent years have seen substantial progress in preoperative patient optimization protocols, anesthesia monitoring, coagulation management, and fluid management, among other areas. These improvements have led to excellent perioperative outcomes for all surgical patients, including those undergoing liver transplantation. In the last few decades, there have been numerous publications in the field of liver transplantation, but controversies related to perioperative management of liver transplant recipients persist. In this review article, we address the unresolved issues surrounding the anesthetic management of patients scheduled for liver transplantation.

The Comparison of Inflation of Cuff with 1% Propofol, 4% Lignocaine, or 0.9% Saline on Laryngotracheal Morbidity.

Background and Aim: While administering general anesthesia requiring endotracheal intubation, it is a common practice to inflate the cuff with air. Continuous pressure exerted by cuff on mucosa may lead to postoperative complaints such as sore throat, cough, and dysphagia, which are very disturbing to the patient. Hence, we hypothesized that inflation of cuff with propofol may reduce the incidence of these complications as a result of cushioning effect as well as non-diffusion of nitrous oxide into it. Our aim was to compare the effects of inflation of endotracheal tube cuff with 0.9% saline, 4% lignocaine, and 1% propofol on the incidence of postoperative morbidity in terms of cough, sore throat, dysphonia, and dysphagia with general anesthesia using nitrous oxide. Methods: Patients scheduled for elective surgery under general anesthesia were randomly allocated into four equal groups of thirty each as per cuff inflation media: air (Group A), 0.9% saline (Group S), 4% lidocaine (Group L), and 1% propofol (Group P). The incidence of cough was noted at 15, 30 and 60 min after extubating. The occurrence and severity of postoperative sore throat (POST) was evaluated at 2, 6, and 24 h after extubating. Results: The incidence of cough was maximum in Group A and minimum in Group P (P < 0.05). The occurrence of POST was highest in Group A, followed by Group S and Group L, and least in Group P. The hemodynamic parameters were comparable with no statistical difference in all the four groups (P < 0.05). Conclusion: The intracuff 1% propofol is superior to 4% xylocaine and normal saline in the prevention of cough and sore throat postoperatively, whereas inflation of cuff with air leads to maximum incidence of these complications.