Anaesthesia in patients with liver disease
- Resource Type
- Authors
- Peter Shirley; Malgorzata H Starczewska; Wint Mon
- Source
- Current opinion in anaesthesiology. 30(3)
- Subject
- Methyl Ethers
medicine.medical_specialty
Chronic liver disease
Risk Assessment
Severity of Illness Index
Perioperative Care
End Stage Liver Disease
03 medical and health sciences
Liver disease
Desflurane
Sevoflurane
0302 clinical medicine
Postoperative Complications
Severity of illness
medicine
Humans
Hypnotics and Sedatives
In patient
Anesthesia
Intensive care medicine
Propofol
Monitoring, Physiologic
Isoflurane
business.industry
Incidence (epidemiology)
Incidence
Opiate Alkaloids
Perioperative
medicine.disease
Prognosis
Anesthesiology and Pain Medicine
Treatment Outcome
Elective Surgical Procedures
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
business
Risk assessment
medicine.drug
- Language
- ISSN
- 1473-6500
The purpose of this review is to summarize the most recent up to date research data and recommendations regarding anaesthetic management of patients with liver disease undergoing surgery. The incidence of chronic liver disease (CLD) continues to rise and perioperative mortality and morbidity remains unacceptably high in this group. Meticulous preoperative assessment and carefully planned anaesthetic management are vital in improving outcomes in patients with liver disease undergoing surgery.The presence of cirrhosis is associated with a significantly increased risk of postoperative morbidity and mortality in patients undergoing elective surgery. The Child--Pugh--Turcotte scale and model for end-stage liver disease (MELD) score remain the most commonly applied scoring systems in preoperative risk assessment, but new MELD-based indices and novel scoring systems might offer better prognostic value. Propofol and new inhalational agents (sevoflurane, desflurane) are recommended hypnotic agents. The titration of opiates in the perioperative period is recommended because of their altered metabolism in patients with liver disease. Perioperative management should include close haemodynamic monitoring and admission to a critical care area should be considered.Patients with liver disease undergoing anaesthesia pose significant challenges and advanced planning and preparation are required in order to improve perioperative outcomes in this group. VIDEO ABSTRACT: http://links.lww.com/COAN/A43.