Anesthesia for patients with hepatocellular disease

Published on 07/02/2015 by admin

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Last modified 07/02/2015

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Anesthesia for patients with hepatocellular disease

Joseph J. Sandor, MD

Knowledge of the varied physiologic functions of the liver (Box 177-1) allows the anesthesia provider to anticipate potential problems when patients with hepatocellular disease present for surgery.

Patients with hepatocellular disease may have altered perioperative coagulation disorders and hypoglycemia. The pharmacokinetics and pharmacodynamics of anesthetic drugs may be altered by alcohol-induced microsomal enzyme induction, which can accelerate the metabolism of drugs and alter the amount of anesthetic drug necessary to achieve a specific anesthetic depth. Hypoalbuminemia increases the pharmacologically active fraction of several protein-bound drugs, which, combined with decreased degradation, results in an increased sensitivity to many drugs (e.g., opioids) in patients with hepatocellular disease.

Acute hepatic failure

Central nervous system manifestations of acute hepatic failure include encephalopathy, altered levels of consciousness, and hyperventilation from vitamin deficiency and increased serum levels of ammonia and other toxic metabolites. Hypoglycemia may result from impaired gluconeogenesis, depleted glycogen stores, and reduced insulin degradation. Cardiac output is increased from reduced systemic vascular resistance and increased arteriovenous shunting. Intrapulmonary shunting may produce hypoxemia. Patients often have coexisting renal disease and are more susceptible to developing infections. Of the proteins synthesized by the liver, factor VII has one of the shortest half-lives (t_1⁄2

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