Key result
Carefully planned anaesthetic management with propofol or new inhalational agents improves outcomes in liver disease.
Why the study?
The incidence of chronic liver disease is rising and perioperative mortality and morbidity remain unacceptably high in patients with liver disease undergoing surgery.
Careful preoperative assessment using scoring systems like MELD and tailored anaesthetic management are essential to mitigate the high perioperative risks in patients with liver disease.
May support tailored anaesthesia in liver disease; leaves open need for prospective trials on specific agents.
PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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.
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Starczewska et al. (2017) conducted a review in Liver disease undergoing surgery. Anaesthetic management was evaluated. Carefully planned anaesthetic management, including preoperative risk assessment and use of propofol or new inhalational agents, is vital for improving outcomes in patients with liver disease.
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