Anesthesia Patients with Concomitant Cardiac and Hepatic Dysfunction.
Anesthesia and surgery in patients with hepatic and cardiac dysfunction poses a challenge for anesthesiologists. It is imperative to optimize these patients perioperatively. Cirrhosis is associated with a wide range of cardiovascular abnormalities. Cirrhotic cardiomyopathy is characterized by blunted contractile responsiveness or systolic incompetence, and/or diastolic dysfunction. In liver disease, anesthetic drug distribution, metabolism, and elimination may be altered. Among patients with liver disease, propofol is a reasonable anesthetic choice and cisatracurium is the preferred neuromuscular blocker. Regional anesthesia should be used whenever appropriate if not contraindicated by coagulopathy, because it reduces the need for systemic analgesia.
Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, North Tower, Room 4209, Los Angeles, CA 90048, USA. Electronic address: Julianne.ahdout@cshs.org.
Julianne
J
Ahdout
Cardiac Surgery Intensive Care Unit, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, Suite A3106, Los Angeles, CA 90048, USA.
Michael
M
Nurok
D000758:Anesthesia / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology; D004452:Echocardiography; D006331:Heart Diseases / Q000150:complications* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000503:physiopathology; D007430:Intraoperative Care; D008103:Liver Cirrhosis / Q000150:complications; D008107:Liver Diseases / Q000150:complications* / Q000503:physiopathology; D011182:Postoperative Care
Anesthesia; Cardiac dysfunction; Liver dysfunction; Perioperative management