martes, 24 de marzo de 2015

Hígado y anestesia / Liver and anaesthesia

Regímenes hipnóticos por vía intravenosa en pacientes con enfermedad hepática; un artículo de revisión.
Intravenous hypnotic regimens in patients with liver disease; a review article.
Soleimanpour H, Safari S, Rahmani F, Jafari Rouhi A, Alavian SM5.
Anesth Pain Med. 2015 Feb 24;5(1):e23923. doi: 10.5812/aapm.23923. eCollection 2015.
Abstract
CONTEXT:The liver as an important organ in the body has many essential functions in physiological processes. One of the major activities of liveris drug metabolism. Hepatic dysfunction affecting hepatic physiological activities, especially drug metabolism can cause many problems duringanesthesia and administration of different drugs to patients. EVIDENCE ACQUISITION: Studies on hepatic disorders and hypnotic anesthetics prescribed in hepatic disorders were included in this review. For this purpose, reliable databases were used. RESULTS:Anesthesia should be performed with caution in patients with hepatic dysfunction and drugs with long half-life should be avoided in these patients. CONCLUSIONS: A review of the literature on the use of hypnotic drugs in patients with liver dysfunction showed that some hypnotic drugs used during anesthesia could be safely used in patients with impaired liver function. In these patients, certain drugs should be used with caution.
KEYWORDS:Anesthesia; Hypnotics Drugs; Liver Disease
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Anestesia en pacientes con enfermedad hepática
Anesthesia for patients with liver disease.
Rahimzadeh P, Safari S, Faiz SH, Alavian SM.
Hepat Mon. 2014 Jul 1;14(7):e19881. doi: 10.5812/hepatmon.19881. eCollection 2014.
Abstract
CONTEXT: Liver plays an important role in metabolism and physiological homeostasis in the body. This organ is unique in its structure and physiology. So it is necessary for an anesthesiologist to be familiar with various hepatic pathophysiologic conditions and consequences of liver dysfunction. EVIDENCE ACQUISITION:WE SEARCHED MEDLINE (PUB MED, OVID, MD CONSULT), SCOPUS AND THE COCHRANE DATABASE FOR THE FOLLOWING KEYWORDS: liver disease, anesthesia and liver disease, regional anesthesia in liver disease, epidural anesthesia in liver disease and spinal anesthesia in liver disease, for the period of 1966 to 2013. RESULTS: Although different anesthetic regimens are available in modern anesthesia world, but anesthetizing the patients with liver disease is still really tough. Spinal or epidural anesthetic effects on hepatic blood flow and function is not clearly investigated, considering both the anesthetic drug-induced changes and outcomes. Regional anesthesia might be used in patients with advanced liver disease. In these cases lower drug dosages are used, considering the fact that locally administered drugs have less systemic effects. In case of general anesthesia it seems that using inhalation agents (Isoflurane, Desflurane or Sevoflurane), alone or in combination with small doses of fentanyl can be considered as a reasonable regimen. When administering drugs, anesthetist must realize and consider the substantially changed pharmacokinetics of some other anesthetic drugs. CONCLUSIONS: Despite the fact that anesthesia in chronic liver disease is a scary and pretty challenging condition for every anesthesiologist, this hazard could be diminished by meticulous attention on optimizing the patient's condition preoperatively and choosing appropriate anesthetic regimen and drugs in this setting. Although there are paucity of statistics and investigations in this specific group of patients but these little data show that with careful monitoring and considering the above mentioned rules a safe anesthesia could be achievable in these patients.
KEYWORDS: Anesthesia; Epidural Anesthesia; Liver Disease; Regional Anesthesia; Spinal Anesthesia
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