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Summer Patho > Hepatic anesthesia considerations > Flashcards

Hepatic anesthesia considerations Flashcards

1
Q

Volatile anesthetics and effects on liver

A

REDUCED HEPATIC BLOOD FLOW!!!!!!

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2
Q

Halothane and the liver

A

Associated with hepatic toxicity - do not use

“halothane hepatitis”

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3
Q

Isoflurane and the liver

A

Great choice - very little reduction in HBF at 1 MAC

Dose-dependent reduction at higher doses

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4
Q

Sevoflurane

A

Good choice - very little reduction of HBF at 1 MAC

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5
Q

Desflurane and the liver

A

Decrease HBF by 30% at 1 MAC

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6
Q

For volatile anesthetics, what does the degree of hepatic metabolism correlate with?

A

The likelihood of a toxic reaction

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7
Q

Metabolism to TFA

A

TFA is a hepatotoxic byproduct

  • halothane - 20%
  • isoflurane - 0.2%
  • desflurane - 0.2%
  • sevoflurane - NONE
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8
Q

N2O and the liver

A

Not known to cause liver injury but can decrease HBF d/t decreased sympathetic stimulation

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9
Q

N2O and vitb12 deficiency

A

Patients with vitb12 deficiency may be at increased risk for neurotoxicity with exposure to N2O

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10
Q

IV anesthetics and the liver

A

As long as CO and BP are maintained, prop, etomidate, and midaz do not appear to affect liver function

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11
Q

What are the major determinants of hepatic clearance

A

Blood flow to the liver
Fraction of drug not bound to plasma proteins
Intrinsic clearance
Vascular architecture

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12
Q

Effects of liver disease on induction agents

A

Clearance is similar to healthy patients, but you are more sensitive to pharmacodynamic effects of induction agents and clinical recovery times can be prolonged

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13
Q

Effects of liver disease on benzos

A

Low extraction ratios

Enhanced sedation and prolonged duration of action

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14
Q

Effects of liver disease on dexmedetomidine

A

Metabolized primarily in liver, so decreased clearance and prolonged half life

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15
Q

Effects of liver disease on opioids

A

Reduced metabolism so increase dosing intervals, single dose less of a problem than gets
Titrate to effect
Avoid meperidine in cirrhosis because plasma clearance reduced
Remifentanil IS THE OPIOID OF CHOICE

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16
Q

Effects of liver disease on succinylcholine/mivacurium

A

Plasma cholinesterase can be reduced in advance liver disease prolonging duration of action

17
Q

Effects of liver disease on roc/vec

A

Clearance, elimination, and duration are all prolonged
Resistance to initial dose will occur d/t gamma globulin concentration and increase vol of distribution d/t edema and ascities

18
Q

Effects of liver disease on at/cisat

A

Not affected by liver disease

19
Q

Induction for patients with liver disease

A

They have hyper dynamic circulation (dec SVR, hypotension, inc CO)

MAINTAIN BP DURING INDUCTION AND MAINTENANCE WITH PRESSORS

20
Q

Vasopressors and patients with liver disease

A

Pts with liver dx have autonomic dysfunction (may be depleted of endogenous vasopressin)

REDUCED responsiveness to pressors, so you may need higher doses

21
Q

Goal of abdominal surgery with hepatic patients

A

Decrease portal pressure to minimize bleeding, consider fluid restriction with CVP monitoring

22
Q

Serum albumin function and liver patients

A

Quantitatively and qualitatively decreased in these patients

Choose albumin rather than crystalloid for periop volume expansion

23
Q

Which g=coat tests may provide more value to ID adequate homeostasis

A

Fibrinogen and viscoelastic test

They measure the complete process of clot formation, stabilization, and clot dissolution

24
Q

TEG and ROTEM and liver patients

A

Have been shown to decrease use of blood products and can confirm preserved hemostatic function despite a prolonged INR

25
Q

Fibrinogen levels and liver patients

A

Suggest to maintain levels 150-200
Higher levels align with levels of fibrinogen required for optimal clot formation on viscoelastic testing
Cryo is preferred to FFP for administration of fibrinogen

26
Q

Abnormalities in platelet number and function in liver disease are in part compensated for by

A

Increased vWF and decreased ADAMTS13

27
Q

At what platelet count is thrombin generation preserved

A

> 50,000/microL

28
Q

Post op LFTs

A

Mild elevations occur frequently after surgery

Elevations >2x normal suggest hepatocellular injury

29
Q

Post op jaundice

A

Commonly caused by reabsorption of surgical or traumatic hematomas or RBC transfusion

Massive transfusion results in large bili load which may overwhelm the liver

Summer Patho (10 decks)

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