Effects of anesthesia and surgery on the liver
- Lawrence S Friedman, MD
Lawrence S Friedman, MD
- Section Editor — General Gastroenterology
- Professor of Medicine
- Harvard Medical School
- Tufts University School of Medicine
- Section Editor
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — General Hepatology
- Section Editor — Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
The effects of anesthesia and surgery on the liver depend upon the type of anesthesia used, the specific surgical procedures, and the severity of liver disease. In addition, perioperative events, such as hypotension, sepsis, or the administration of hepatotoxic drugs, can compound injury to the liver occurring during the procedure.
This topic review will summarize the influence of these factors, while an overall approach to assessment of the risk of surgery in patients with liver disease is presented separately. (See "Assessing surgical risk in patients with liver disease".)
MILD VERSUS CLINICALLY APPARENT LIVER DYSFUNCTION
Mild elevations in serum aminotransferase, alkaline phosphatase, or bilirubin concentrations are common following surgical procedures regardless of the type of anesthesia used, and they usually resolve without further consequences [1,2].
Clinically important hepatic dysfunction is uncommon, but is much more likely in patients with preexisting liver disease. A review of 733 patients with cirrhosis who underwent surgery at the Mayo Clinic found a perioperative mortality rate of 11.6 percent and a complication rate of 30 percent, which is much higher than would be expected for a population without liver disease . A number of risk factors for mortality or complications were identified including a high Child-Pugh score, the presence of ascites, an elevated serum creatinine concentration, preoperative upper gastrointestinal bleeding, and a high American Society of Anesthesiologists physical status rating (table 1).
TYPE OF SURGERY
The type of surgery is probably the most important determinant of postoperative hepatic dysfunction in patients with liver disease . The following are general principles:
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