Login

Journal Image
Current Clinical Pharmacology
ISSN (Print): 1574-8847
ISSN (Online): 2212-3938
Epub Full Text Article
DOI: 10.2174/1574884709666140212110036      Price:  $95









Anesthetic Pharmacology and Perioperative Considerations for the End Stage Liver Disease Patient

img
Author(s): Robert L. Mcclain, Harish Ramakrishna, Stephen Aniskevich, Joseph A. Cartwright, Leah G. Ward, Sher-Lu Pai, Eduardo S. Rodrigues, Archer K. Martin and Timothy S. Shine
Abstract:
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. This is particularly true in the anesthetic management of the patient with hepatic pathology as the liver plays a central role in the absorption, distribution, and elimination kinetics of most drugs and many active and inactive drug metabolites. 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
Affiliation:
Department of Anesthesiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA