Hepatic, Renal and Endocrine Anesthesia Flashcards

Which volatile anesthetic agent is considered MOST hepatotoxic and carries the highest risk of immune-mediated fulminant hepatic necrosis?

Answer: Halothane

Halothane undergoes extensive reductive and oxidative hepatic metabolism, producing reactive intermediates that trigger immune-mediated hepatocellular necrosis (halothane hepatitis) at an incidence of ~1:10,000.

In a patient with end-stage liver disease, the volume of distribution of highly protein-bound drugs is most likely to:

Answer: Increase due to hypoalbuminemia increasing free drug fraction

Hypoalbuminemia in liver failure increases the unbound (free) fraction of protein-bound drugs, effectively increasing their volume of distribution and pharmacodynamic effect.

The hepatic artery supplies approximately what percentage of total hepatic blood flow?

Answer: 25%

The hepatic artery provides approximately 25% of total hepatic blood flow but delivers about 50% of hepatic oxygen supply due to its high oxygen content.

During liver transplantation, the anhepatic phase is associated with which hemodynamic change?

Answer: Hypotension due to inferior vena cava (IVC) occlusion and reduced venous return

Clamping the IVC during the anhepatic phase dramatically reduces venous return to the right heart, causing significant hypotension that may require venovenous bypass or careful fluid management.

Which coagulation abnormality is MOST commonly seen in advanced liver disease?

Answer: Decreased production of vitamin K-dependent factors II, VII, IX, X

The liver synthesizes clotting factors II, VII, IX, and X (vitamin K-dependent); advanced liver disease impairs their production, prolonging PT/INR.

Succinylcholine duration of action is prolonged in severe liver disease primarily because of:

Answer: Decreased plasma pseudocholinesterase production by the liver

Plasma pseudocholinesterase (butyrylcholinesterase) is synthesized by the liver; its deficiency in hepatic failure slows succinylcholine hydrolysis and prolongs neuromuscular blockade.