Total Intravenous Anaesthesia and an Opioid-Sparing Strategy for an Extended Left Hemihepatectomy with Total Caudate Resection, Total Hepatic Vascular Exclusion, and Venovenous Bypass: An Integrative Anaesthesia Approach.

We present a case of a 72-year-old man who underwent an open extended left hemihepatectomy and total caudate lobe resection with total hepatic vascular exclusion (THVE) for a large hepatocellular carcinoma (HCC). Anaesthetic management included the use of intrathecal opioids and total intravenous anaesthesia (TIVA) with propofol and remifentanil. Due to tumour adherence to the right hepatic vein-inferior vena cava junction, venovenous (VV) bypass and cold in situ perfusion were required. This case illustrates neurocognitive protection principles, electroencephalogram (EEG)-guided depth of anaesthesia monitoring, multimodal opioid-sparing analgesic strategies, enhanced recovery principles, and sustainable, low-emission TIVA anaesthetic maintenance, exemplifying an integrative approach in high-complexity liver surgery.