From the Research
Elevated liver function tests (LFTs) can significantly impact anesthesia for surgery, and the decision to proceed should be based on the severity and cause of the abnormalities, with consideration of the most recent evidence from 2021 1. When evaluating the impact of elevated LFTs on anesthesia for surgery, it's crucial to consider the severity and cause of the abnormalities. Patients with mildly elevated LFTs may still undergo surgery, but those with significantly abnormal values (typically AST or ALT >3 times normal, or elevated bilirubin) may require postponement until the cause is identified and treated.
- Before surgery, patients with elevated LFTs should undergo evaluation to determine the underlying cause, which might include viral hepatitis, medication effects, alcohol use, or other liver diseases.
- Anesthesiologists may modify their approach by choosing anesthetic agents that undergo less hepatic metabolism, such as sevoflurane or desflurane instead of halothane, and avoiding medications that could further stress the liver.
- Dosages of medications metabolized by the liver may need adjustment, and maintaining adequate liver blood flow during surgery is crucial, as is avoiding hypotension that could further compromise the liver.
- Postoperatively, patients with liver dysfunction may experience delayed drug clearance, requiring closer monitoring for side effects and prolonged drug effects, as noted in studies such as 2 which highlighted the clinical significance of abnormal LFTs in patients with COVID-19. The liver's role in producing clotting factors also means that coagulation studies should be checked before surgery in patients with significant liver dysfunction to assess bleeding risk, emphasizing the need for a comprehensive approach to managing patients with elevated LFTs undergoing anesthesia for surgery, as guided by the most recent and highest quality evidence available 1.