British Journal of Anaesthesia, 2002, Vol. 88, No. 6 757-760
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia
Editorial |
Editorial II
Assessment of liver function: its application to outcome from liver transplantation
1Nuffield Department of Anaesthetics, University of Oxford, Oxford, UK
The liver has a number of separate yet integrated functions. Assessment of hepatic behaviour during anaesthesia and the perioperative period generally involves tests that assess only part of the liver’s overall function, and assumes that behaviour in one area of activity reflects its function in other areas.
The functions of the liver can broadly be broken down into seven main areas: catabolic and anabolic functions with respect to carbohydrate, fat, and protein metabolism; production of bile; production and excretion of bilirubin; immunological functions involving the production and release of cytokines and interferons; scavenging and filtration of endotoxins and bacteria; storage of vitamin B12 and glycogen; and the biotransformation and elimination of drugs and xenobiotics.
While the hepatologist may use the prothrombin ratio or perhaps plasma pre-albumin concentrations (half-time 1–2 days) as a marker of the well-being of the liver for patients in acute liver failure, the chronic liver patient is
Capacity-limited, binding-insensitive hepatic elimination
Capacity-limited, but binding-sensitive hepatic elimination (for example digitoxin, mexilitine, midazolam, erythromycin, and tolbutamide)
Flow-limited elimination
References