Current clinical pharmacology | 14 Feb 2014
RL McClain, H Ramakrishna, S Aniskevich, JA Cartwright, LG Ward, SL Pai, ES Rodrigues, AK Martin and TS Shine
The number of patients with end stage liver disease is growing worldwide. This is likely a result of advances in medical science that have allowed these patients to lead longer lives since the incidence of diseases such as alcoholic cirrhosis and viral hepatitis have remained stable or even decreased in recent years, at least in more developed nations. Many of these patients will require anesthetic care at some point. The understanding and application of basic principles of pharmacokinetics is paramount to the practice of anesthesia. An understanding of pharmacokinetic principles provides the anesthesiologist with a scientific foundation for achieving therapeutic objectives associated with the use of any drug; however, pathologic conditions often alter the expected kinetic profile of many drugs. This is particularly true in the anesthetic management of the patient with hepatic pathology as the liver plays a central role in the absorption, distribution, and elimination kinetics of most drugs and many active and inactive drug metabolites. We review normal liver physiology, pathophysiology of liver disease in general, and how liver failure affects the pharmacokinetics and pharmacodynamics of anesthetic agents; providing some specific examples.
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