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ANAESTHESIA IN PATIENTS WITH LIVER DISEASE First broadcast on www.provet.co.uk |
This information is provided by Provet for educational purposes only.
You should seek the advice of your veterinarian if your pet is ill as only he or she can correctly advise on the diagnosis and recommend the treatment that is most appropriate for your pet.
Compromised liver function is present in patients showing overt signs of liver disease, but it may also be present in patients with subclinical disease. At risk populations (such as the elderly) should be screened for evidence of liver dysfunction prior to the administration of a general or local anaesthetic or other agents which might be contraindicated in such patients.
Many drugs are metabolised by the liver. If there is hepatic dysfunction drugs may not be eliminated properly, and the concentration of drug in the body accumulates causing toxicity, or it's action is prolonged with potentially adverse consequences for the patient. In addition, some drugs which are used routinely in conjunction with patients undergoing anaesthesia may further damage the liver through their own hepatotoxicity.
This table lists the drugs in common use prior to, during, or after general or local anaesthesia and whether or not they should be avoided. Drugs that are solely eliminated through the liver and for which there is no specific antedote present the greatest risk to a patient and should be avoided.
| DRUG | NEED TO AVOID IN LIVER DISEASE | OTHER POSSIBLE RISK SITUATIONS |
| Acepromazine | YES | Pregnancy, epilepsy. |
| Acetaminophen (paracetamol) | YES | Is hepatotoxic |
| Alphadolone and Alfaxalone | NO | Dogs |
| Atropine | NO | Cardiac disease (tachycardia, ventricular arrhythmias, myocardial ischaemia), glaucoma |
| Benzodiazepine | YES | If hepatic encephalopathy is present |
| Buprenorphine | NO | Prolonged action in liver disease. Respiratory disease, head injuries, increased intracranial pressure |
| Butorphanol | YES | Head injuries and raised intracranial pressure |
| Compound analgesics a non-opioid with an opioid (eg codeine with paracetamol/acetaminophine) | YES | |
| Dexmedetomidine | NO | Cardiovascular disease, debilitated animals, pregnancy |
| Etomidate | YES | Care if used in hepatic failure patients |
| Fentanyl | NO | May be prolonged activity in hepatic failure patients |
| Gallamine | NO | Renal impairment |
| Halothane | NO | Cardiovascular and respiratory depression, arrhythmias, vasodilation, hypotension |
| Isofluorane | NO - agent of choice | Cardiovascular and respiratory depression, arrhythmias, vasodilation, hypotension |
| Ketamine | YES | Renal impairment, pregnancy |
| Lidocaine | YES | Cardiac impairment, pregnancy |
| Medetomidine | NO | Cardiovascular disease, debilitated animals, pregnancy |
| Methadone | NO | Head injuries and increased intracranial pressure |
| Methohexitone | NO | |
| Methoxyfluorane | YES | Renal impairment |
| Midazolam | YES | If hepatic encephalopathy is present |
| Morphine | NO | Head injuries and raised intracranial pressure |
| Nitrous oxide | NO | |
| Pancuronium | YES | Renal impairment, obesity |
| Paracetamol (acetaminophen) | YES | Is hepatotoxic |
| Pentazocine | NO | Head injuries and raised intracranial pressure |
| Pentobarbitone | YES | |
| Pethidine | NO | Renal impairment, Head injuries and raised intracranial pressure, pregnancy |
| Procaine | NO | |
| Propofol | YES | Care if used in hepatic failure patients, also in patients with impaired cardiac, renal and respiratory function. |
| Suxamethonium | YES | |
| Thiopentone | YES | Reduced cardiac output |
| Vecuronium | YES | |
| Xylazine | NO | Pregnancy, Gastro-intestinal obstruction, pulmonary disease |
Isoflurane is the gaseous anaesthetic agent of choice because hardly any biotransformation occurs in the liver. Both Etomidate and Propofol are also recommended by some authors as they are eliminated rapidly in the presence of liver disease but they are contraindicated in advanced liver disease.
Updated January 2016