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p- pp pp p*p./p0 1p
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 p
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 pp p      p   p%
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 p  ppp p p   p , , p  p  pp
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5p   p p
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p p pp p

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 p
pp p p p    p  
p *p p p p p
     p p  pp p  p(   p  pp  p
  
 p  p
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 p(  p  pp pp pp
p  p&p
   p p p   p!p  p  p p  p  p
 p  p"75p p6   p5  p6!5p p
ppp p pp
 p    p

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pppp
p p  p p  p  p  p p  p pp
  pp pp pp p;<=p p  p p$%$p  p p
p 2 
p+p  p  p p.<=p  pp(
p
 p   p ppp p p  2p p   p p
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!p
pp p  p pp  p p p  p pp

    p   
p
p  p   p p p  p p*  p p
 pp
p pp  p(  ppp   p
p   pp p p    pp pp p p
 p

pp pp p*   p
ppppp
    p p pp  
 p  p(   p p p p
  p  pp  p p p   p p p   p
6  p pp
    p
pp 
p  p p  p p
 , , pp p p   p  
pp'7  p 'p
 p

Table 1: Liver Failure: mode of presentation and survivalp

 p !!#p % 




p p  p

p

( p 7 p >1p p

$%$p p ?p @AB@p )C=p

$%$p p ?p ;@;p @D=p

$%$p%
 ?p EBp .D=p
 p

  p

!p   pp p p p pp p $pp p p!p@p
" p pF&p  p   pp p  p
p p p  p 2 pp p
$%$p  pp p p  pp    pp,p p
  p pp*p p;p  p p  p p  p   p p
 
p p
p p p# pp ppppp   p
 p%  p:p%:4p p(p%(4p  p   p pB/=p ppp!p
 p 
p p p   p p p%:4p p%(4p p  p p
 p p p pp p  p p p%((p

"   p p%(4ppp  p!p  p p%(4p  ppp


 p p p p pp p   p%(4p 2 
p p p  p
  ppp p p p p p p p pppp p p
  p p p p p p  p;/=p p%(4p   p p p
p  p p  p/=p p pp p%:4p( p%(4p   pp  p p p

p pp p)/p
p p  p p pp p p p7 p 
p p
 
p p
  p  p   p 
ppp p p
  p p 
p p p pp   p   pp p p    p

 & # "p

" p)ADCp(p p! p pp p  p pp p   p
  p   p p  p p  p
   p6p pp p& 'p
( p%  ppp
p  p
 p p  p   p
 p    p p p  pp!p  p
 pp p
 p p ppp
p pp p  p p p
p  
pp!p.p

"# '!# p

!p(6p   ppp p  p p  p p p pp


    p% p p ppp pp p p p
p p  p p
pp(  
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p 
p p  p
 p pp   p p p  p" pp  ppp
    pp p   p p p pp p 
p  p
  p p'
p 'p pp p p  pppc 
' &p p p  pp pp pp  p p  p
p p

p

% p ppp  p   p p  p p p%:4p p


%(4p   p5 pp  p p p  p;<<p p@<<<ppp
pp
)<<<<<p 
p  p p p+ pp  p  p  
p p
 p  p p  p p p/=)<=p

() p p p* 


pp  pp pp p
 p p  p pp p p p( p 
p ppp
  
p p 
p 
pp p p
p6 p  p pp
 p p p  p 3p

`p  
p p   p p pp  p   p p
p
`p 6  
 p   p p  p
   3p p p p
 p  p   p   
ppp  p    p
   p
`p 6    p  p p  p ppp     pp
p p   p

% p  p p  p p+ p:1(p  pp p  p  


p p
  p/<=pp

Table 2: Causes of Liver Failure (UK)p


p c*p
"   p
"   pp
miralp
miral A-E, Non A-Ep
:
p    p
pp
1°: PBCp
e.g. paracetamol, rifampicin,
2°: Congenital,
phenytoin, halothanep
stonep
! * pp
  p
  p p
! * p
8  p
p
Wilson's Diseasep
  p
Fatty liver of pregnancyp
8  pp
HELLPp
 'pp
Lymphomap
)  
 p
Sepsisp
  
p
Reye's syndromep
4  pp
Heatstrokep
Budd-Chiarip

pp

Table 3: Child-Pugh Scorep

  p
$!
 p
+p ,p -p

   
pp 7 p )@p .Cp

8  p p
 p  p 8p
p

E./p .DD<p
: p GD<p0 1p
0 1p 0 1p

 p G./p1p @;./p1p E@;p1p

6!pp  Hp )Cpp CDpp GDpp

I"75Jp IE)BJp I)B@.Jp IG@.Jp

H p   p p p"75p

(6pp pEpDpp
(6p:p pBApp
(6p(p pG)<p
c 
    
  p

$ p p p p p   p pp p p  pp p


p
p p''p  ppp p!
p3pp

)p 8pp  pp(6p+ pp


@p %pp  pp(6p+ p:1(p
.p 8  p p  p p pp

ã   
  p

" p p p p  p pp pp' 'p p p p
 p   p  2p pp  p
p p  p% p
# p p pp p pp p p  p  p p   p

p p pp p# p ppp 
p p2 p p
p p p  p ppp

p p
p  p p pp p  p p p
  p 
p*   p p    p"p p p(6pp
  pp  p p!pCp!p    p ppp p   
p
 
p p pp pp  p pp 

p" pp p p p p
 p p   pp p p p p  pp  p  p p p
 p6  p p pp
    p p pp  p1p p p
 p p p p   
p p pp p p  p
  p6  p  p  p p p   ppp p 
pp 
p pp 

p
p  p pp p 
 p
   
p p
pppp pp  p p pp
p ppp p p  pppp  p  p p
  pp

Table 4: Peri-operative considerations in Child-Pugh


A patientsp

6    
p p   pp  
pp
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pp
: p  p p  pp
(  p pp
p p    pp
6 p   p

6 ( pp 


ppKp
 p  pp* ppp
5 p  2p p p
  p p
6   8  p p    p p
 p     p
6 p  p  p p  p p
 p%Fp1p"!Fpp
5 p  2p
ppp p p p p   
p pp 
p
 p p    p p  p6  ppp p   p pp p
  p p*  p  p
p p pp
   p pp  p"  pp p p  p p p
  p p  pp p p
p  p
pp p p
  pp   
p p p p p  p p p  p  p  p
 pp p8  p p  
pp 
p p

6   p%Fp p"!Fp p pp p pp+ pp  p


   p# p
p p p p  p   p p  p p
 p 
p   p

ü 
 
   p

6  p p p pp


pp p pp p   p p
!p pp  p  p p 
p
p
  p
 p p
  p pp  p p ppp p 
p p p
 p pp p p!p/p6 pp  p
p
  p
   p p   
p 
p p p  p p
 p p pp p  p  p p
  p
  p;)@p  p p p  p p  , pp p  p p
pp p* p p p  p  pp
p p
 p p pp p p ppp p p p p p

.p

 p p pp p p p   p  p9 pp

pp p  
p p p  p p%@p p   p

p p
 pp p   p!p p p  p  p pp
p p   ppp p #  p pp p
(   
p
p2p   p p p  , pp p  p p p
 p 
p
p p pp p

.  p

!p  p p   p  2p p+ pp  p p
p2
p p
pp p+ p:1(p  p5 p  2p p pp p 
p
p  p  pp p p p p   
Lp ppp p p
 p  pp9 pp p p  p  p p+ p:1(p
  p 3p

  p pp  p p p  p  p p p p p
p p p pp;/p$+p p pp p  p   p
8   p p p p p ppp  
p6 
p 
p
 
p
ppp pp   p p
pp

p p pp  p!p
p p  2ppp    p
  
p p  p 
p   p1pp p 
p
 p p   p  p   p p p  p  p p p
  p  p  p pp
 p pp   p pp
 p  p pp p pp p"!Fp
p   
p   p"!Fp 
p p
p 
pp

Table 5: Pre-operative considerations in Child-Pugh B/C patientsp

Historyp    
p6 pp  p
p
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pp
(43p*p  p p    pp
53p
 p pp pp
+"3p p p ppp
p1p p   pp
8  3 p1p  p

Examinationp Fp6 Fppp


 p p
 p
(43pp p pp:6p pp
53pp p  p pp
 3p p p ppp
(7pp p   p   
p
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"(63p   p  pp
4 pp*  p>p  p
Encephalopathyp +/pp  p 
p  p p p
,/p  p  p pp pp
  p
-/p p  
p p p  p
p
p  p pp
0/p  pMp p p pK p p
p p
Ynvestigationsp (+p(N5Lp: pp  
pp p
   pp9@p  p: p  p  p
"75p6!5Lp4p  
LpF   pp  p
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p
p  pp  pLp   
p
   
p

"$#  pp# p  p!p  p pp p


 p p p  p  p ppp pp pp
 p p pp( p  p p p p5p  p
   p p"7516!5p
pp 
p   
p    
p
 p p   p  p p   p

( p: p   p pp'p'p pp p


 
p p p  ppp pp  p
p pp  p

   p p pp
p pp
p
 !/7

  p7(ppp   p
  * p  pp p  p p   p  p p   p p p
7(pp p p *
 p
p p   p ppp  p

p

5 p    pp  pp p p  p p  p p



p
pp p  p p p p  p p p p
p p  p
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pp p p p p    p  p  p
  p
p pp p

 ."p

6  pp2p    p p p p  pp  p pp p p


  p p
p p p  p p   p p p
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p p  p pp  p p p    pp p
pp p p  p  p p p pp 
p pp
  p p  p pp  pp pp 
p!p p
   pp
p pp  p pp p p    p
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  p pp p2 p p p p  p p p
  p p 
p p p p p p p p p  p
 p
pppp p p p p p pp  p
  p p p 
p  p
pp 
p   
pp$  ppp
 p p p p  p  p p p p
ppp
   p   
p p ppp p pp

Analgesia and sedationp

" p *p  pp pp  p  p pp pp
 p p p  pp p  pp  p9 p  
p p
  p pp p
p  p  p p  p p, p p  p

    p

!p  p 


p p p  p p p  pppp
 pp pp p
pp p  
p  p2 p p
p p p p   p p p  p p  p  p
2 ppp  3p

)p     p pp    pp  p


 p p
     p p p  p p*p pp" &$p
: p p pp   p
p p* p  pp
    p p p p  p p p 
p  p   p
@p " #  p 
p ppp 
p ppp p p p
 p p p
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 pp   p ppp p  p p  
 p
  p
Cp " p pp  p  p    pp   p
 p p p p p p p  p pp   p  
p
 p  p p p!p p  pp pp p p p
pp p  p  
p
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 p  p   p pp  p8  
pp  pC<=p
   
p p!"6p!  p"  p6  
 p p
 p
ppp!p  p p p p* p p
  p  p p p p p  p p p
 p  p  p
pp 
p

Principles of anaesthetic managementp

: p  pppp     p   p p pp


p p  p p  pp  p p p  p   
 p
   
p p p9p  
pp.<=p!p    p
pp
  p p
p pp p p p p p!p p p   p
  ppp3p

`p 6  p p
p
`p  p ppp
`p 4 p pp  p p p  , pp p  p p
 p
`p (p1p  p  p+p4  p&p  p  
p pp
 p 
p

8
p p p  p  p p   p p(6p+ p:1(p
  p
pp  p   pp

p
p
p
p
p

p
p
p
p
p
p
c  
   
 

( p5 p$p(5$p


ppp
p
p pp p
p
 p
pp p  p p 
ppp p  p    p p p p
p pp
p p  p(5$p 
p p 
p p pp
 pC<=p p p  pp     p
p p p p
 
pp 
p p2p pp  p)<=p p  pp
    p6  p p(5$pp p
p pp  p  p   p
 p
   pp

Preoperative Assessment and Treatment of Medical Problems in Renal Failurep

!p   p  p pp p p pp  p p  p


 p p p p p p 
p p

$p" p(5$p p p p*  pp 


p *p p  p
p!p 
p pp 
p  p pp p p p

  p!pp p
  p ppp p pp
p p p
 p*   p p p p p#p pp p p
  p p p p p 
p p p   p" p
 p p p pp
p  
pp  p8
p  p
p
p pp p p p
 p p p p p
  pp
p

!p  p pp   p p p


p$p   p p

pp p p p p p pp p p p p p pp p
pp

(!$p  p  p p  p p* p p


p p pp p p  p   p p p p pp
   p ppp
p p pp

%
pp  pppp p p p  p/p 1p(+p p
 p p pDBp 1p p p   pp p p pp
 pp pBp 1p(+p p p pp!pp   pO!p
 p pO5p *p p p p6pp 
p pO5p
 *pp p p!pp p pp pp  p4 p
  p
p p pp    p p)<p 1p

8  p p   ppp p p p 


p 3pp

ã p  
p
p p
pã p p
 p p p pp
 p p pp p p p
pp
  p p
 p p
p p
p p p 
p
p
p 
 p
p p
p p!
p p p 
p
p!
 p
ppp
pppp p"

p
pp
pp
p


pppp! pp #p

pp pp
p p  p
 p  p p $ã pp
p

pp pp p
pp 
 p! p 
ppp
p
p
p p
#pp! p p 
p
p!
 p p

p
p

ppp 
p  p
% p  
p
pã$p
p
p 
 p 
p
p $
ã p pp!
p p p
p p p
p p p
pp
  p
& p 'p  
p p$p p p pp
p()p
pp p

! p 
p pp p  pp3pp

ã p "p  p
 p *p p
p pp+p
pp p
p
  pp
 p !!
 pãp
p
p!
p p  p
% p "pp

p
p p
p!
 p p

c   p pp p


p
p    p p  p   p
 p 
pp p p p%ppEB@pp  p p  p   p
 p
  p p p  pp

   pHypertensionp


ppp
p p 
p p
 p p p p   p p p*p  p   p: pp pp
  p  
pYschaemic heart diseasepp p  p p pp
p  
pPulmonary oedemap
p p p p  p p p
 p p pPericarditisp p p pp   p

 #pPulmonary oedemap ppleural effusionsp pppp


 p p  p    pp
p p p   1  p
 pp p p p p p
 *p pp p  p
p p
 p p p p
p

"pChronic anaemiapp  p p  p p(5$p pp


p p  p p
    p pp
pp  pF p p  p
pp pp p   pp
pp  p p  pB;p
1pFp  p
pppbleeding tendencypp ppp p  p
 p p 
p p pppp

   # p *p p   p p  p p  p


 p pppp  p
 p!p p* p
  p
7   pp  p p p p pp  p pp

  # pFppp  pp p


p
 p 
p ppp p p p  
p p
pp
  p

 # pHyperparathyroidismpp p   p p p p


  p p p p  p p  p
pp  pp p
p  
p p  p

s p6  p


pp  p     p p p
  pp pp p9 p   p
pp p
p p  pp
#  "p! p  p p p p p p pp  p p
 p
p p  p
 p p 
p p p  p% 
p
 pp
p   p p p   pp p)@p p p p
 p
p

Pharmacology of Anaesthetic Agents in Renal Failurep

!pexcretionp p p pp p p p   pppp


$ pppp 
p* p p p p p 
p p    p
 p    p pp  p p pp  p p p p p
p
 p  p  p p p    p
p p 
p
pppp
 p p p* 
p
p p p 
p 
p

" !p  pp   p


p   pp p p pp

p p p pp  p  
p p  p p p
p

s 1 pSuxamethoniump pp p p


pp p

 p   pp* p p p p 


p p   p
Atracuriumpp p p p pp p  p   p%  p  p
 p 
p  p

mecuroniump pmivacuriumpp p pp p p pp 


pp p
p* p 
pp

Gallaminep pp p ppancuronium, alcuronium, pipecuronium, curare


and doxacuriump ppp p  p6    p p  p p

p p p p p pp  p p
 p
 p
p
 p p p  ppp 
 p8  p
 p p p p

 pMorphinepp  p p pp p  D ppp


  p p p p  p p  p pp
p  p p p
6  pp 
p  p p   pppp p pp
*  
p p  p  p: p p p   p
p p p
 p p p p p p p  p  p   ppp
p
pp p  pp  pp p p  p

# pp pppp p

(22 p ppp p p p

!" !ppp   p p p  p ppp


   p   p p  p  p p  *
 pp p
  p p    p p p   p p pp p
p p
p p p  pp

 #" 3 c4p pp ppp


p p p  p p
p  p  p p p
Conduct of Anaesthesiap

p9p ppp,p p ,p


ppp%@p
   p p p  p pp p  p pp p p
 p *ppp p

c ! pmenous accessp


pp  p" p  p 
pp p pp
   p pp4p  p p  p  p p$ p p  p
 p pp p p p p p  pp

Full monitoringp pp p p p   p p  p pp


   p pp p p(+p p pp!p  p pp pp
*
  p p 

p p%
  p p
   p  p
 p    p  p p p p p p pp 
pp" p
 p p  p  p p p ppp

" p p pp  pp p p p  p pp p p
p p p    pp p  p p pp9 p
   p p  p
p   p
pp

 #pPostoperative fluid balancep pp  p p  p  p


 p p p   p pp
p p  p p  p
p2p
haemodialysisp p p  p   
p p p pp
p p p
p p  ppp pp p p  p
p p 
p p
 
p p p p p

Oxygenp@.p 1  p 


p p.Cp 1  pp pp pp
  p pC;p p p# p  p p  p
p p@Cp p
 p  p
ppp

"c
pp

6 
p 
p  p  p pp p  p p p p  pp
 p pp p p pp*  p p pp
 #p
p p 
p
pp pp p p p5 p
pp p p p   pp  
pE</11 p p pp
   pp

!p   p p   p p p2 p p  ppp p
 p  p   p  p p  p p p p!p 
 p p
 p pp  p p  pp pp p p2 p
  p
p p 
p
p p pp p!p p   p p
pp 
p p pp  p p)p11p

9 
p p p  ppp  p p p p  pppp
p  p p2 p p p pp p p  p pp p
p p  Pp  p pp" p p  p p p p
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