| Summary: | A perioperative risk is increased in patients with advanced liver dysfunctions and is much higher in emergencyoperations than in elective surgeries. Perioperative mortality depends on the level of liver damage and isassessed using Child’s classification where patients are assigned to three groups A, B and C according to fiveeasily-assessed parameters: bilirubin concentration (A < 2.0, B 2.0-3.0, C > 3.0 mg/dl), albumin concentration (A >3.5, B 3.0-3.5, C < 3.0 g/dl), intensification of ascites and encephalopathy (A none, B easy to control, C difficult tocontrol) and nutritional status (A perfect, B good, C poor). Additionally, the assessment of prothrombin time maybe helpful. Mortality for each group A, B and C is 10%, 31% and 76%, respectively. The classification also significantlycorrelates with such complications as bleeding, renal failure, wound dehiscence and sepsis. The main causeof death is multiorgan failure in sepsis.In 1996, the ASA (American Society of Anesthesiologists) recommended critical values for the number ofplatelets, prothrombin time and fibrinogen concentration which are required for transfusions of blood products in rodmassivetransfusions and microcapillary bleeding: (1) transfusion of platelet concentrates is usually recommendedif the number of platelets is < 50 000/mm3 (when the parameters are 50 000-100 000/mm3 the transfusiondepends on the risk of serious bleeding), (2) transfusion of fresh frozen plasma is recommended if prothrombintime or APTT is > 1.5 the normal range, (3) transfusion of cryoprecipitate is recommended if the concentrationof fibrinogen is < 80-100 mg/dl. Transfusion of cryoprecipitate is also recommended in perioperative prophylaxisin non-bleeding patients with fibrinogen deficits or with von Willebrand disease with or without haemorrhagicdiathesis.Preoperative preparation which consists of correction of symptoms connected with advanced liver diseases(optimization of parenteral and oral feeding with additional doses of vitamin B1, correction of clotting disturbancesby transfusion of FFP and/or cryoprecipitate, reduction of concomitant encephalopathy, prevention ofsepsis with prophylactic antibiotic therapy, monitoring of renal function with careful correction of electrolytedisturbances) may significantly improve the results of surgical treatment.
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