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Case Report

Anaesth Pain & Intensive Care. 2022; 26(1): 119-122


Perioperative challenges in the management of a Jehovah's witness patient undergoing a parenchyma sparing hepatectomy

Vihara Dassanayake, Sivasuriya Sivaganesh, Duminda Subasinghe, Prabodha Pitigala.


Abstract

Jehovah’s Witness patients presenting for liver surgery pose challenges to both anaesthetists and surgeons due to their abstinence from receiving blood products. Despite this, surgery is the only curative option for operable colorectal liver metastases (CRLM). We report a case of a Jehovah’s witness with multiple comorbidities who had a parenchyma sparing hepatectomy (PSH) complicated by intraoperative bleeding.

A 52-year-old ASA II patient with hypertension, diabetes and ischaemic heart disease on dual antiplatelet therapy was scheduled for open PSH for multiple bilobar CRLMs. He was prehabilitated with an emphasis on enhancing erythropoiesis and improving his functional capacity. Clopidogrel was withheld one week prior to surgery. PSH was done using a cavitron ultrasonic surgical aspirator (CUSA) with intermittent Pringle manoeuvre, with low central venous pressure and restricted intravenous fluids. Intra-operative blood loss was 1550 ml with an operative duration of 7 ½ hours and total Pringle time of 2 hours. He received 10 units of cryoprecipitate and human albumin according to the advance directive. His postoperative recovery was complicated by a minor upper gastrointestinal bleed that was managed conservatively.

Key words: Jehovah’s witness, Liver surgery, Anaesthesia, hepatectomy






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