Anesthesia for Patients with Liver Disease Last updated: 05/08/2024 Key Points Patients often present for anesthesia with no documented history of liver disease. Around 75% of the liver must be affected before signs and symptoms become apparent. Hepatic dysfunction exists on a spectrum of severity ranging from mild, asymptomatic disease to severe, end-stage liver disease with profound physiologic and metabolic implications. As liver disease progresses, multiple critical organ systems, including the heart, kidneys, and nervous system, are affected. 1,2 Introduction Hepatic dysfunction is a complex and multifaceted medical condition that presents unique challenges in the field of anesthesiology. The liver performs a multitude of metabolic and synthetic functions and plays a pivotal role in drug metabolism, coagulation, and detoxification. Hepatic dysfunction can significantly affect the pharmacokinetics and pharmacodynamics of anesthetics and other perioperative medications. 1,2 Ane...