The number of patients with end stage liver disease is growing worldwide. This is likely a
result of advances in medical science that have allowed these patients to lead longer lives since the
incidence of diseases such as alcoholic cirrhosis and viral hepatitis have remained stable or even
decreased in recent years, at least in more developed nations. Many of these patients will require
anesthetic care at some point. The understanding and application of basic principles of
pharmacokinetics is paramount to the practice of anesthesia. An understanding of pharmacokinetic
principles provides the anesthesiologist with a scientific foundation for achieving therapeutic
objectives associated with the use of any drug; however, pathologic conditions often alter the expected kinetic profile of
many drugs. Anesthesia providers caring for these patients must be aware of the altered pharmacokinetics that may occur
in these patients. We review normal liver physiology, pathophysiology of liver disease in general, and how liver failure
affects the pharmacokinetics and pharmacodynamics of anesthetic agents; providing some specific examples.
Keywords: Anesthesia, end stage liver disease, hepatic failure, liver transplant, pharmacodynamics, pharmacology.
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