Neuroanesthesia and Liver Disease

Abstract

In a patient with liver disease coming for an intracranial procedure, the clinician should keep in mind the pathophysiology of the liver disease while planning a strategy for controlling the intracranial pressure. Maintaining the cerebral perfusion pressure in a patient with a compromised cerebrovascular reserve is a challenge.

The prime issues in neuroanesthesia that an anesthesiologist is required to tackle are brain relaxation, hyperventilation, arterial blood pressure management, use of steroids, osmotherapy, diuretics, anticonvulsant use, patient positioning, intraoperative blood loss, and intravenous fluid management. The prime concerns in a patient with liver disease include coagulation problems, malnutrition, potential ascites, abnormal metabolism of drugs, pulmonary hypertension, high cardiac output and a low systemic vascular resistance state, bleeding from esophageal varices, potential for hepatorenal syndrome, and hepatic encephalopathy.