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Anesthesia for Patients with Liver Disease

Last updated: 05/08/2024


Hemodynamic Stability

  • Patients with hepatic dysfunction are at risk for circulatory instability; thus, maintaining hemodynamic stability is crucial. Invasive arterial blood pressure monitoring may be necessary to guide fluid management and vasopressor support, depending on the patient’s disease severity and the extent of the intended procedure. TEE may be a useful adjunct to assess cardiac function in patients with advanced liver disease.2

Coagulation Management

  • Coagulopathies should be assessed and addressed by using blood products such as fresh frozen plasma, cryoprecipitate, and platelets. The use of desmopressin should be considered to enhance platelet function. Depending on the extent of bleeding during the procedure, the clinician may consider the use of plasma-derived and recombinant clotting factor concentrates (e.g., fibrinogen concentrate, prothrombin complex concentrate, recombinant activated clotting factor VII) to improve coagulation parameters.3

Postoperative Care

  • Even for patients with liver disease at the milder end of the spectrum, the risk of decompensation following surgery requires extra care to be taken. Patients with worsening hepatic dysfunction may require specialized care in the intensive care unit for close monitoring of hemodynamics, coagulation status, and the management of hepatic encephalopathy.2

References

  1. Simmons F, Pustavoitau A, Merritt WT. Diseases of the Liver and Biliary Tract. In: Hines RL, Jones SB. eds. Stoelting’s Anesthesia and Co-existing Disease. 8th ed. Elsevier, Philadelphia, PA; 2022: 333-46.
  2. Ramsay M. Anesthesia for Patients with Liver Disease. In: Butterworth JF, Mackey DC, Wasnick JD. eds Morgan & Mikhail's Clinical Anesthesiology. 7e. McGraw-Hill Education, Accessed April 27, 2024. Link
  3. Kujovich JL. Coagulopathy in liver disease: a balancing act. Hematology Am Soc Hematol Educ Program. 2015:2015: 243-9. PubMed
  4. Nardelli S, Riggio O, Gioia S, et al. Spontaneous portosystemic shunts in liver cirrhosis: Clinical and therapeutical aspects. World J Gastroenterol. 2020;26(15):1726-32. PubMed
  5. Maher SZ, Schreibman IR. The clinical spectrum and manifestations of acute liver failure. Clin Liver Dis. 2018;22(2):361-74. PubMed
  6. Friedman LS. Surgery in the patient with liver disease. Trans Am Clin Climatol Assoc. 2010; 121:192-204. PubMed
  7. European Association for the Study of the Liver. EASL clinical practice guidelines: Liver transplantation. J Hepatol. 2016;64(2):433-85. PubMed

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