Anaesthesia in liver disease patient. Baharulhakim Said b Daliman Department of Anaesthesiology & Intensive Care Hospital Kuala Terengganu. www.anaesthesia.co.in [email protected] Objectives. It is an important topic? Physiology Pharmacology ~ Phase I & II metabolism
albumin can be decreased with liver disease
colloid osmotic pressure will be reduced
fewer binding sites for drugs and the unbound, active portion of protein-bound drugs will be increased example : Thiopental.
Clotting factors perioperative management of patients with liver disease, and much of the research is based on retrospective analyses V, VII, IX, X, prothrombin and fibrinogen are all dependent on the liver for synthesis ~ many of the factors require only 20-30% of normal levels to stop bleeding, significant impairment of liver function must occur before problems begin.
Plasma half-lives of clotting factors are measured in hours. Therefore, acute liver dysfunction can lead to coagulopathies.
Both severe parenchymal disease and biliary disease may lead to coagulopathy - the former due to impaired synthesis and the second by decreased vitamin K absorption due to the absence of bile salts secondary to biliary obstruction.Physiology
Divided into 2 phase:
Factor affecting drug metabolism:
Pharmacokinetic changes cause by liver disease:
Pharmacodynamic changes occur because:
Classic symptoms are:
Aberrations of physiology in chronic liver disease:
# clinical pearl is to decrease the drug dosage by half and modify as needed (Conn, 1991).
Extreme peripheral vasodilation ► extreme ↓ arterial blood volume & hypotension
Activates homeostatic mechanism ► vasoconstriction of renal vasculature
↓ GFR & plasma renin remains high with salt & water retention
Prognosis is poor
Most of us will never take part in a transplant but the lessons learned can be applied each time we administer anesthesia to a patient with hepatic disease
iii. Liver dialysis machine
(molecular adsorbent recirculating system)