[Anesthesiologic aspects of surgical interventions in patients with liver diseases].

The authors review the anesthesiology problems in hepatic patients on the one hand, and on the other hand they present their personal experience in anesthesia of patients with jaundice, upper digestive haemorrhage and hepatic coma. The conclusions of the study are the following: 1. The major hepatic functions which can interfere with anesthetic drugs and techniques are related to changes in the hepatic blood flow, the synthesis of proteins, homeostasis of carbohydrates, and especially the metabolization of medicinal drugs. 2. Hepatic patients presenting with jaundice, upper digestive haemorrhage, and hepatic coma raise special problems concerning preoperative preparations and anesthetic technique. Considering the risk factors which occur in the patient with jaundice denutrition, hypoalbuminemia and partially angiocholitis can be corrected by medical means. Hemostasis on hepatic patients with upper digestive haemorrhage is the most difficult problem, and also very controversial. There are not, at present, either infallible solutions or arguments in favor of hemostatic techniques (by compression, endoscopic haemostasis, or surgical hemostasis). The comatose patient is usually the final evolutive stage of the hepatic disease, and the mortality in this category of patients, indifferent of the therapy, is higher than 80%.