Anesthesia for Patients With Liver Disease

Abstract

Context:Liver plays an important role in metabolism and physiological homeostasis in the body. This organ is unique in its structure and physiology. So it is necessary for an anesthesiologist to be familiar with various hepatic pathophysiologic conditions and consequences of liver dysfunction.Evidence Acquisition:We searched MEDLINE (Pub Med, OVID, MD Consult), SCOPUS and the Cochrane database for the following keywords: liver disease, anesthesia and liver disease, regional anesthesia in liver disease, epidural anesthesia in liver disease and spinal anesthesia in liver disease, for the period of 1966 to 2013.Results:Although different anesthetic regimens are available in modern anesthesia world, but anesthetizing the patients with liver disease is still really tough. Spinal or epidural anesthetic effects on hepatic blood flow and function is not clearly investigated, considering both the anesthetic drug-induced changes and outcomes. Regional anesthesia might be used in patients with advanced liver disease. In these cases lower drug dosages are used, considering the fact that locally administered drugs have less systemic effects. In case of general anesthesia it seems that using inhalation agents (Isoflurane, Desflurane or Sevoflurane), alone or in combination with small doses of fentanyl can be considered as a reasonable regimen. When administering drugs, anesthetist must realize and consider the substantially changed pharmacokinetics of some other anesthetic drugs.Conclusions:Despite the fact that anesthesia in chronic liver disease is a scary and pretty challenging condition for every anesthesiologist, this hazard could be diminished by meticulous attention on optimizing the patient’s condition preoperatively and choosing appropriate anesthetic regimen and drugs in this setting. Although there are paucity of statistics and investigations in this specific group of patients but these little data show that with careful monitoring and considering the above mentioned rules a safe anesthesia could be achievable in these patients.

Sevoflurane may be more beneficial than propofol in patients receiving endoscopic variceal ligation and endoscopic variceal sclerotherapy: A randomized, double-blind study

“…Endoscopic variceal ligation (EVL) and endoscopic variceal sclerotherapy (EVS) are highly accepted by doctors and patients due to minimal trauma, significant effects, fast recovery and notable improvement in patient quality of life (12). Patients who require EVL or EVS often accept general anesthesia, which contains inhalational anesthesia and intravenous anesthesia (13).…”

Anaesthetic management in Wilson's disease with severe neuropsychiatric manifestations

“…There are several pain rating scales defined in paediatric age group and in patients with cognitive impairment like CHEOPS, FLACC, Baker-Wong FACES and COPT. 9 The use of these scales become difficult in patients with severe psychotic symptoms, limb rigidity and labile affect. Hence, the adequacy of block was primarily judged by vital parameters and observation of behavioural changes 10 .…”

“…7,8 Drugs with extra hepatic metabolism such as remifentanil, propofol, cis-atracurium and atracurium are safe in presence of hepatic dysfunction. 9 Postoperative pain management was challenging in view of altered drug metabolism. Opioids were restricted due of possibility of accumulation and resultant respiratory depression.…”

“…The key point against block was the risk of nerve damage as it was performed under anaesthesia and due to the rare possibility of polyneuropathy in Wilson's disease that may or may not be related to penicillamine treatment. 9 Ultrasound guidance enabled visualization of neural structures and adequate spread of local anaesthetic around the plexus. Another concern was pain assessment in postoperative period.…”

“…Also, they interfere with neurological assessment and can aggravate existing symptoms. 9 We avoided NSAIDs due to their propensity to cause renal dysfunction. Hence, an interscalene brachial plexus block was given for postoperative analgesia to reduce systemic analgesics.…”