Awetahagn Abreha

CHAPTER 38

ANAESTHESIA AND LIVER DISEASE

Outline: Problems Techniques

1

Other general disorders: Patients with liver disease are usually in a poor physical state. Abnormal response to drugs: − The response to drugs that are de-toxified in the liver can be prolonged or abnormal in patients with liver disease. − Drugs broken down by enzymes manufactured in the liver.Awetahagn Abreha PROBLEMS The liver is able to sustain a considerable amount of damage without much loss of function but operations and anaesthetics must be avoided when patients have serum or infective hepatitis.g. Larger doses of pancuronium/ vecuronium may be needed. e. Toxic drugs: Drugs that are toxic to the liver must not be used. − In advanced liver disease the platelet count may be low due to hypersplenism. depolarising relaxants such as suxamethonium have a prolonged effect. In liver disease the albumin level falls but the globulins rise. − Certain drugs like pancuronium and vecuronium are bound to the globulin fraction of plasma proteins. These drugs must therefore be given in small doses. Halothane is probably safe to use in these patients if there are no alternative agents. Vitamin K (the water soluble analogue) must be given preoperatively (10mg IV slowly). Examples are thiopentone.g. which is necessary for blood to clot. e. chronic bronchitis is common. 2 .g. Anaemia is often present. In some regions many patients are Hepatitis C positive. chlorpromazine. morphine and local anaesthetics. e. − Due to decreased vitamin K absorption they have a low level of prothrombin. Bleeding tendency: Patients with liver disease have a bleeding tendency.

however. It is advisable. 3 . In fact.Awetahagn Abreha Hypotension. TECHNIQUES OF ANAESTHESIA In liver disease a regional anaesthetic should be used whenever it is possible. The amount of local anaesthetic used may need to be assessed carefully. Each of these can aggravate liver dysfunction and cause postoperative renal failure. avoiding them requires more attention than choosing the type of drug that will be used for anaesthesia. to test the patient's coagulation studies before a regional anaesthetic is used. Renal disease and hepatic disease often co-exist. as a bleeding tendency is a relative contraindication to a regional technique. similar to that recommended for patients with renal dysfunction. If a general anaesthetic is needed then a very careful anaesthetic must be given. hypoxia and hypercarbia must be avoided.

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