Preoperative Evaluation and Management of Patients with Liver Disease

Abstract

Patients with liver disease who undergo surgery have an increased risk of morbidity and mortality. Impairment of the liver functions increases the risks of surgery and anesthesia.The risk depends on the severity of liver disease, nature of the surgery and comorbid conditions. Patients with compensated cirrhosis and normal synthetic function have a low risk. Elective surgery should be postponed in patients with abnormal liver tests. All patients should have thorough preopera‐ tive evaluation, and their conditions are to be optimized before elective surgery. Thorough history and physical examination usually provide important informata‐ tion. Elective surgery can be rescheduled or cancelled once the severity of underlying liver disease is assessed. When surgery is mandatory, meticulous perioperative management is required, including hemodynamic stability, broad- spectrum antibiotics, correction of coagulopathy, improvement of nutritional status, avoidance of nephrotoxins and sedatives that could precipitate hepatic encephalop‐ athy, and intensive care unit admission if needed. Keywords: