In a patient with liver disease coming for an intracranial procedure, the clinician should keep in mind the pathophysiology of the liver disease while planning a strategy for controlling the intracranial pressure. Maintaining the cerebral perfusion pressure in a patient with a compromised cerebrovascular reserve is a challenge.
The prime issues in neuroanesthesia that an anesthesiologist is required to tackle are brain relaxation, hyperventilation, arterial blood pressure management, use of steroids, osmotherapy, diuretics, anticonvulsant use, patient positioning, intraoperative blood loss, and intravenous fluid management. The prime concerns in a patient with liver disease include coagulation problems, malnutrition, potential ascites, abnormal metabolism of drugs, pulmonary hypertension, high cardiac output and a low systemic vascular resistance state, bleeding from esophageal varices, potential for hepatorenal syndrome, and hepatic encephalopathy.
This is a preview of subscription content, log in to check access.
Schepke M, Heller J, Paschke S, et al. Contractile hyporesponsiveness of hepatic arteries in humans with cirrhosis: evidence for a receptor-specific mechanism. Hepatology. 2001;34:884.CrossRefGoogle Scholar
Rodriguez-Roisin R, Krowka MJ. Hepatopulmonary syndrome–a liver-induced lung vascular disorder. N Engl J Med. 2008;358:2378–87.CrossRefGoogle Scholar
Rodriguez-Roisin R, Krowka MJ, Herve P, et al. Pulmonary-hepatic vascular disorders (PHD). Eur Respir J. 2004;24:861–80.CrossRefGoogle Scholar
Joist JH. AICF and DIC in liver cirrhosis: expressions of a hypercoagulable state. Am J Gastroenterol. 1999;94:2801–3.CrossRefGoogle Scholar
Frink EJ, Morgan SE, Coetzee A, et al. The effects of sevoflurane, halothane, enflurane, and isoflurane on hepatic blood flow and oxygenation in chronically instrumented greyhound dogs. Anesthesiology. 1992;76:85–90.CrossRefGoogle Scholar
Hunter JM, Parker CJ, Bell CF. The use of different doses of vecuronium in patients with liver dysfunction. Br J Anaesth. 1985;57:758–64.CrossRefGoogle Scholar
Magorian T, Wood P, Caldwell J, et al. The pharmacokinetics and neuromuscular effects of rocuronium bromide in patients with liver disease. Anesth Analg. 1995;80:754–9.PubMedGoogle Scholar