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