ISSN 2398-2942      

Anesthesia: in liver insufficiency

icanis
Contributor(s):

John Dodam


Considerations

  • Hypovolemia and hypotension decreasehepatic perfusionand slow excretion of many drugs.
  • Splanchnic vasoconstriction and positive pressure ventilation decreasehepatic blood flow.
  • Some anesthetic drugs arehepatotoxicin susceptible individuals, ie halothane Halothane.
  • Hypoalbuminemiadue to decreased albumin synthesis predisposes to ascites and edema and affects distribution of protein-bound drugs (greater proportion of unbound active drug).
  • Ascitic fluidmay interfere with breathing.
  • If excess diuretics used to manage ascites → risk ofmetabolic alkalosis Acid base imbalance.
  • Hematological abnormalities:anemia,impaired coagulation.
  • Diseased hepatic cells have decreased ability to metabolize and/or excrete drugs.
  • Increased susceptibility tohypoglycemia Hypoglycemia : prolongs recovery, may cause seizures.
  • Disturbedacid-base homeostasis(impaired hepatic glutamine synthesis/lactate metabolism).
  • Decreased urea synthesis and increased blood ammonia: risk ofhepatic encephalopathy Hepatic encephalopathy.
  • Impaired reticulo-endothelial function: increases risk ofendotoxemia/septicemia Shock: septic.
  • Endocrine disturbances caused by decreased hormone catabolism.
  • Malabsorptionof lipids and fat-soluble vitamins.

Pre-anesthetic management

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Premedication

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Induction

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Maintenance

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Recovery

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Further Reading

Publications

Refereed papers

Other sources of information

  • Greene S A (1996) Hepatic Disease. In: Thurmon J C, Tranquilli W J & Benson G J (eds) Lumb and Jones' Veterinary Anesthesia. 3rd edn. Lea and Febiger.
  • Ilkiw J E (1994) Anesthesia and Disease. In: Hall L W & Taylor P M (eds) Anesthesia of the cat. Bailliere Tindall. (Section in feline anesthesia text but contains excellent discussion of anesthesia and disease relevant to all species.)

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