Given the history of seizures, present hepathopathy and mild coagulopathy, I recommend the following protocols and anesthetic techniques for this planned surgical procedure.
Oral Keppra 750 mg PO prior to surgery (am dose)
Cerenia 1 mg/kg IV (1 hr before induction)
Hydromorphone 0.1 mg/kg IV or Fentanyl 5 mcg/kg IV with a fentanyl infusion at 3-6 mcg/kg/hr
Diazepam or midazolam 0.3 mg/kg IV
Propofol 4-6 mg/kg IV
Preoxygenation via face mask for 5 minutes before induction
Monitoring: SPO2, ECG, non-invasive blood pressure, capnography and temperature
Ventilation: Positive pressure ventilation at 8-12 mls/kg with a respiratory frequency of 8-10 breaths/min and a peak-inspiratory pressure of 10-15 cmH2O. End-tidal CO2 should be maintained between 35-45 mmHg, and given that this is a laparoscopic procedure, the recommendation is to hyperventilate the patient to an end-tidal CO2 of 30-35 mmHg before insufflation of the abdomen to ensure adequate expansion of the lungs before abdominal distention inherent to the surgery. Maintain the patient on positive pressure ventilation until the abdominal cavity is deflated and the surgeon is beginning their closure.
Fluid Therapy: 3 mls/kg of a balanced crystalloid with 5 ml/kg boluses as necessary for intraoperative bleeding.
Hypotension: Dopamine 3-10 mcg/kg/min infusion
Additional information: I recommend considering the administration of another dose of keppra IV in the post-surgical period to prevent any seizure-like activity which can be common in the preoperative setting.
Hydromorphone 0.05 mg/kg IV PRN or continue the fentanyl CRI at 2-4 mcg/kg/hr. I do not recommend an NSAID given the present liver disease.