TY  - CHAP
M1  - Book, Section
TI  - Chapter 33. Anesthesia for Patients with Liver Disease
A1  - Ramsay, Michael
A2  - Butterworth, John F.
A2  - Mackey, David C.
A2  - Wasnick, John D.
PY  - 2013
T2  - Morgan & Mikhail's Clinical Anesthesiology, 5e
AB  - Because  of  the  increased  risk  of  perioperative  morbidity  and  mortality,  patients  with  acute  hepatitis  should  have  any  elective  surgery  postponed  until  the  acute  hepatitis  has  resolved,  as  indicated  by  the  normalization  of  liver  tests.  Isoflurane  and  sevoflurane  are  the  volatile  agents  of  choice  because  they  preserve  hepatic  blood  flow  and  oxygen  delivery.  Factors  known  to  reduce  hepatic  blood  flow,  such  as  hypotension,  excessive  sympathetic  activation,  and  high  mean  airway  pressures  during  controlled  ventilation,  should  be  avoided.  In  evaluating  patients  for  chronic  hepatitis,  laboratory  test  results  may  show  only  a  mild  elevation  in  serum  aminotransferase  activity  and  often  correlate  poorly  with  disease  severity.  Approximately  10%  of  patients  with  cirrhosis  also  develop  at  least  one  episode  of  spontaneous  bacterial  peritonitis,  and  some  patients  may  eventually  develop  hepatocellular  carcinoma.  Massive  bleeding  from  gastroesophageal  varices  is  a  major  cause  of  morbidity  and  mortality,  and,  in  addition  to  the  cardiovascular  effects  of  acute  blood  loss,  the  absorbed  nitrogen  load  from  the  breakdown  of  blood  in  the  intestinal  tract  can  precipitate  hepatic  encephalopathy.  The  cardiovascular  changes  observed  in  the  patient  with  hepatic  cirrhosis  are  usually  that  of  a  hyperdynamic  circulation,  although  clinically  significant  cirrhotic  cardiomyopathy  is  often  present  and  not  recognized.  The  effects  of  hepatic  cirrhosis  on  pulmonary  vascular  resistance  vessels  may  result  in  chronic  hypoxemia.  Hepatorenal  syndrome  is  a  functional  renal  defect  in  patients  with  cirrhosis  that  usually  follows  gastrointestinal  bleeding,  aggressive  diuresis,  sepsis,  or  major  surgery.  It  is  characterized  by  progressive  oliguria  with  avid  sodium  retention,  azotemia,  intractable  ascites,  and  a  very  high  mortality  rate.  Factors  known  to  precipitate  hepatic  encephalopathy  in  patients  with  cirrhosis  include  gastrointestinal  bleeding,  increased  dietary  protein  intake,  hypokalemic  alkalosis  from  vomiting  or  diuresis,  infections,  and  worsening  liver  function.  Following  the  removal  of  large  amounts  of  ascitic  fluid,  aggressive  intravenous  fluid  replacement  is  often  necessary  to  prevent  profound  hypotension  and  kidney  failure.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2021/09/22
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=57235838
ER  -