Anesthesia for Patients with Obstructive Jaundice

Yue Long , Weidong Mi , Weifeng Yu
Anesthesiology and Operation Center, CPLA General Hospital, Beijing, China, Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
J Anesth Perioper Med 2018; 5(3): 149- 160 . Published on May 29, 2018 . doi:10.24015/JAPM.2018.0058
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Aim of review: Obstructive jaundice is associated with high perioperative morbidity and mortality due to diverse pathophysiologic derangements. Proper preoperative evaluation and preparation, and optimal perioperative anesthetic management contribute significantly to a favorable outcome for patients with obstructive jaundice during the perioperative period. In this review, we attempt to summarize the pathophysiological changes induced by obstructive jaundice and update the anesthetic management of jaundiced patients.
Methods: Review of recently published literature (from January, 1960 to December, 2017) related to obstructive jaundice and anesthetic management. Keywords searched include “obstructive jaundice” or “cholestasis”, “anesthetic management”, “pathophysiology” or “physiopathology” or “pathology and physiology”.
Recent findings: Obstructive jaundice causes a series of pathophysiological changes, including changes in blood biochemistry and metabolism, coagulation, infection, liver injury, renal dysfunction, cardiovascular instability, malnutrition, stress ulcer, bacterial translocation, immunosuppression and other adverse events, all of which may increase the mortality and morbidity during the perioperative period. The alterations in pharmacological properties of many narcotic drugs caused by obstructive jaundice vary widely. And the requirements of many anesthesia-related drugs, such as rocuronium, desflurane and etomidate, are reduced in patients with obstructive jaundice.  
Conclusion: Pathophysiological changes associated with obstructive jaundice need to be improved preoperatively. Anesthesiologists should be aware of the importance of rational use of narcotic drugs in patients with obstructive jaundice during operation. Multidisciplinary collaboration is required for the treatment of such patients perioperatively. (Funded by the National Natural Science Foundation of China.)
Citation: Yue Long, Weidong Mi, Weifeng Yu. Anesthesia for Patients with Obstructive Jaundice. J Anesth Perioper Med 2018;5:149-60. doi: 10.24015/JAPM.2018.0058
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