martes, 24 de marzo de 2015

Más de hígado y anestesia/More on liver and anaesthesia

Papel de los anestésicos inhalados en pacientes con disfunción hepática. Una revisión.
The role of inhalational anesthetic drugs in patients with hepatic dysfunction: a review article.
Soleimanpour H1, Safari S2, Rahmani F3, Ameli H4, Alavian SM5.
Anesth Pain Med. 2015 Jan 7;5(1):e23409. doi: 10.5812/aapm.23409. eCollection 2015Author
CONTEXT: Anesthetic drugs including halogenated anesthetics have been common for many years. Consequent hepatic injury has been reported in the literature. The mechanism of injury is immunoallergic. The first generation drug was halothane; it had the most toxicity when compared to other drugs. The issue becomes more important when the patient has an underlying hepatic dysfunction. EVIDENCE ACQUISITION: In this paper, reputable internet databases from 1957-2014 were analyzed and 43 original articles, 3 case reports, and 3 books were studied. A search was performed based on the following keywords: inhalational anesthesia, hepatic dysfunction, halogenated anesthetics, general anesthesia in patients with hepatic diseases, and side effects of halogenated anesthetics from reliable databases. Reputable websites like PubMed and Cochrane were used for the searches. RESULTS: In patients with hepatic dysfunction in addition to hepatic system and dramatic hemostatic dysfunction, dysfunction of cardiovascular, renal, respiratory, gastrointestinal, and central nervous systems may occur. On the other hand, exposure to inhalational halogenated anesthetics may have a negative impact (similar to hepatitis) on all aforementioned systems in addition to direct effects on liver function as well as the effects are more pronounced in halothane. CONCLUSIONS: Despite the adverse effects of inhalational halogenated anesthetics (especially halothane) on hepatic patients when necessary. The effects on all systems must be considered and the necessary preparations must be provided. These drugs are still used, if necessary, due to the presence of positive effects and advantages mentioned in other studies as well as the adverse effects of other drugs. KEYWORDS: Halothane; Hepatitis; Inhalational Anesthetics
Riesgos perioperatorios en pacientes con enfermedad hepática sometidos a cirugía no hepática
Perioperative risk factors in patients with liver disease undergoing non-hepatic surgery.
Pandey CK1, Karna ST, Pandey VK, Tandon M, Singhal A, Mangla V.
World J Gastrointest Surg. 2012 Dec 27;4(12):267-74. doi: 10.4240/wjgs.v4.i12.267.
The patients with liver disease present for various surgical interventions. Surgery may lead to complications in a significant proportion of thesepatients. These complications may result in considerable morbidity and mortality. Preoperative assessment can predict survival to some extent inpatients with liver disease undergoing surgical procedures. A review of literature suggests nature and the type of surgery in these patientsdetermines the peri-operative morbidity and mortality. Optimization of premorbid factors may help to reduce perioperative mortality and morbidity. The purpose of this review is to discuss the effect of liver disease on perioperative outcome; to understand various risk scoring systems and their prognostic significance; to delineate different preoperative variables implicated in postoperative complications and morbidity; to establish the effect of nature and type of surgery on postoperative outcome in patients with liver disease and to discuss optimal anaesthesia strategy in patients withliver disease. KEYWORDS: Cirrhosis; Liver disease; Perioperative risk
Anestesia y Medicina del Dolor
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