Anesthesia Patients with Concomitant Cardiac and Hepatic Dysfunction

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Julianne Ahdout, Michael Nurok

Teaser

Anesthesia and surgery in patients with hepatic and cardiac dysfunction poses a challenge for anesthesiologists. It is imperative to optimize these patients perioperatively. Cirrhosis is associated with a wide range of cardiovascular abnormalities. Cirrhotic cardiomyopathy is characterized by blunted contractile responsiveness or systolic incompetence, and/or diastolic dysfunction. In liver disease, anesthetic drug distribution, metabolism, and elimination may be altered. Among patients with liver disease, propofol is a reasonable anesthetic choice and cisatracurium is the preferred neuromuscular blocker. Regional anesthesia should be used whenever appropriate if not contraindicated by coagulopathy, because it reduces the need for systemic analgesia.


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