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Anesthesia for the patient with liver disease

Randolph H Steadman, MD, MS
Victor W Xia, MD
Section Editor
Stephanie B Jones, MD
Deputy Editor
Marianna Crowley, MD


Patients with liver disease frequently require surgery and anesthesia, and are at increased risk of intraoperative complications and postoperative morbidity and mortality. This topic will discuss anesthetic management of patients with liver disease.

Epidemiology, diagnosis and management of various forms of liver disease, and preoperative risk assessment for patients with liver disease, are discussed separately. (See "Assessing surgical risk in patients with liver disease".)


Screening for liver disease — The preoperative history and physical examination for any patient should include the risk factors, signs, and symptoms of liver disease. Routine screening with liver function tests (LFTs) is not recommended, due to its low yield and uncertain implications for patients with no known liver disease. (See "Assessing surgical risk in patients with liver disease", section on 'Screening for liver disease before surgery'.)

Preoperative evaluation for patients with known liver disease — Prior to surgery, the etiology, duration, and severity of hepatic dysfunction should be determined. Risk stratification and optimization of medical status should be performed preoperatively for elective surgery.

Risk stratification — A number of conditions are considered contraindications to elective surgery (table 1), including acute liver failure (previously termed fulminant hepatic failure) and acute viral or alcoholic hepatitis. Patients with mild to moderate chronic liver disease without cirrhosis usually tolerate surgery well. (See "Assessing surgical risk in patients with liver disease", section on 'Obstructive jaundice'.)

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Literature review current through: Nov 2017. | This topic last updated: Jul 18, 2017.
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