title: Use of remifentanil in a patient with chronic hepatic failure.
abstract: We describe a 73-yr-old woman anaesthetized for a laminectomy. She suffered from hepatic failure with mild encephalopathy complicated by several exacerbations associated with sedative and opioid therapy. The challenge for anaesthesia management was to provide adequate analgesia and avoid causing hepatic encephalopathy during and after the surgery. We used remifentanil to provide intraoperative and postoperative analgesia, because it has a short duration of action and does not require hepatic metabolism. We closely monitored the respiratory and the neurological status throughout the administration and conclude that remifentanil can provide perioperative analgesia in patients at risk of developing hepatic encephalopathy.
authors.affiliation: Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospital, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Dumont
authors.forename: V
authors.initials: V
authors.lastname: Picard
authors.forename: R A
authors.initials: RA
authors.lastname: Marti
authors.forename: E
authors.initials: E
authors.lastname: Tassonyi
mesh_terms: D000368:Aged; D000698:Analgesia / Q000379:methods; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D016080:Arachnoid Cysts / Q000601:surgery; D002908:Chronic Disease; D000075202:Contraindications; D005260:Female; D006801:Humans; D007796:Laminectomy; D017093:Liver Failure; D010149:Postoperative Pain / Q000517:prevention & control; D010880:Piperidines / Q000627:therapeutic use*; D000077208:Remifentanil
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil