Table 3.

Management Principles to Prevent and Treat CNS Complications.

Optimization of cerebral blood flow:	a.Elevate head of bed by 20–30° b.Correct fluid balance and avoid volume overload c.Maintain MAP at ~60–70 mm Hg d.Hyperventilate to keep PCO2 at 35–40 mm Hg
Prevent surges in ICP	a.Minimize head turning b.Avoid bilateral internal jugular vein cannulation c.Invasive ventilation for grade 3 and 4 hepatic encephalopathy with adequate sedation and analgesia (short-acting agents such as propofol and fentanyl) d.Minimize suctioning and stimulation: use lidocaine e.Treat agitation with intubation and sedation; paralyze if necessary f.Monitor for seizures: (EEG to detect nonconvulsive seizures) g.Induce hypernatremia to a sodium concentration of ~150 mmol/L Mannitol (0.5–1 g/kg body weight IV bolus) when required liver transplantation: assess need and futility
Rescue measures	a.Hypothermia b.Indomethacin c.Total hepatectomy

CNS = central nervous system; MAP = mean arterial pressure.