title: Anaesthesia in patients with liver disease.
abstract: OBJECTIVE
  The purpose of this review is to summarize the most recent up to date research data and recommendations regarding anaesthetic management of patients with liver disease undergoing surgery. The incidence of chronic liver disease (CLD) continues to rise and perioperative mortality and morbidity remains unacceptably high in this group. Meticulous preoperative assessment and carefully planned anaesthetic management are vital in improving outcomes in patients with liver disease undergoing surgery.
  
  
  RESULTS
  The presence of cirrhosis is associated with a significantly increased risk of postoperative morbidity and mortality in patients undergoing elective surgery. The Child--Pugh--Turcotte scale and model for end-stage liver disease (MELD) score remain the most commonly applied scoring systems in preoperative risk assessment, but new MELD-based indices and novel scoring systems might offer better prognostic value. Propofol and new inhalational agents (sevoflurane, desflurane) are recommended hypnotic agents. The titration of opiates in the perioperative period is recommended because of their altered metabolism in patients with liver disease. Perioperative management should include close haemodynamic monitoring and admission to a critical care area should be considered.
  
  
  CONCLUSIONS
  Patients with liver disease undergoing anaesthesia pose significant challenges and advanced planning and preparation are required in order to improve perioperative outcomes in this group. VIDEO ABSTRACT: http://links.lww.com/COAN/A43.
authors.affiliation: aAdult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust bUniversity College London Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Malgorzata H
authors.initials: MH
authors.lastname: Starczewska
authors.forename: Wint
authors.initials: W
authors.lastname: Mon
authors.forename: Peter
authors.initials: P
authors.lastname: Shirley
mesh_terms: D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D000077335:Desflurane; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D058625:End Stage Liver Disease / Q000150:complications / Q000453:epidemiology / Q000378:metabolism / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D015994:Incidence; D007530:Isoflurane / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects; D008991:Monitoring, Physiologic; D053610:Opiate Alkaloids / Q000008:administration & dosage / Q000009:adverse effects / Q000378:metabolism; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D015742:Propofol / Q000008:administration & dosage; D018570:Risk Assessment; D012720:Severity of Illness Index; D000077149:Sevoflurane; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D053610:Opiate Alkaloids; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane; D015742:Propofol