Liver disease (fitness for anaesthesia)
The patient with liver disease does not present a significant problem until substantial damage has occurred, as the residual mass of tissue is capable of increasing its functional turnover. Potential problems include:
- decreased plasma proteins for drugs to bind to - requires modulation of drug doses
- decreased oncotic pressure and hence an increasing tendency to oedema with crystalloid solutions
- altered cerebral metabolism secondary to hepatic changes reduces the need for analgesics and sedatives
- reduction of clotting factors: monitor the INR
- jaundice:
- increases the likelihood of per- and post-operative haemorrhage; necessitates vitamin K prophylaxis
- risk of renal failure due to the action of bilirubin on the renal tubules; osmotic diuresis may help
- risk of delirium tremens in alcoholic patient: prophylactic chlormethiazole may be required
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