Impact of Liver Disease on Use of Muscle Relaxants in Anesthesia: A Comprehensive Review

01 January 2025 : Review article

Paweł Radkowski

^{ABCDEFG 1,2,3}, Maciej Szewczyk

^{ABCDEFG 4*}, Anna Łęczycka^{BEF 5}, Kacper Kowalczyk^{BEF 5}, Mariusz Kęska

^{BEF 1,2}, Tomasz Stompór

^{DG 6}

DOI: 10.12659/MSM.945822

Med Sci Monit 2025; 31:e945822

Introduction Liver Function Tests and Assessment of Liver Function AST and ALT The De Ritis Ratio Chronic Liver Disease Liver Cirrhosis Steatotic Liver Disease Acute Liver Failure Acute-On-Chronic Liver Failure Characteristic of Succinylcholine Impact of Hepatic Insufficiency on Succinylcholine Use Characteristics of Benzylisoquinolones Atracurium Characteristic and Its Use in Hepatic Insufficiency Cisatracurium Characteristic and Its Use in Hepatic Insufficiency Mivacurium Characteristic and Its Use in Hepatic Insufficiency Aminosteroids Charateristics Pipecuronium Characteristics and Uses in Liver Insufficiency Pancuronium Characteristics and Use in Patients with Hepatic Insufficiency Vecuronium Characteristic and Its Use in Hepatic Insufficiency Rocuronium Characteristic and Its Use in Hepatic Insufficiency Neostigmine and Its Use in Hepatic Insufficiency Sugammadex Characteristic and Its Use in Hepatic Insufficiency Summary of Neuromuscular Blocking Agents Use in Hepatic Insufficiency and Actual Recommendations Future Directions Conclusions References

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Table 1 Comparison of steatotic liver disease-connected diagnoses nomenclature, which evolved through the years with its diagnostic criteria.

NAFLD criteria	MAFLD criteria	MASLD
	The presence of hepatic steatosis (verified through imaging techniques and/or histological techniques – liver biopsy);And at least one between these 3 conditions:
NAFLD – non-alcoholic fatty liver disease, MAFLD – metabolic dysfunction-associated fatty liver disease, MASLD – metabolic dysfunction-associated steatotic liver disease.

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