01 January 2025 : Review article
Impact of Liver Disease on Use of Muscle Relaxants in Anesthesia: A Comprehensive Review
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
Table 3 Scales and criteria used for assessment and prediction in cirrhotic patients.
| Name of scale | Describtion of scale |
|---|---|
| The Child-Pugh score | Also known as the Child-Pugh-Turcotte score, it is used to predict mortality in cirrhosis patients, particularly in relation to major surgeries. It assesses parameters such as presence of jaundice, bilirubin levels, albumin levels, and prothrombin time, assigning appropriate scores. Based on these scores, patients are classified into 3 classes – A, B, and C. It is considered that |
| Model of end-stage liver disease (MELD) | It is a scale used to predict survival in individuals with liver cirrhosis, assessing 3-month mortality rates. This scale was originally developed to predict survival following TIPS procedures.MELD evaluates serum creatinine, bilirubin levels, and INR. In 2021, an updated version of the scale, MELD 3.0, was introduced, which includes sex, INR, bilirubin, sodium, creatinine, and albumin in its calculationsHigher MELD scores are associated with worsening liver function and increased 3-month mortality rates. In 2023, the Organ Procurement and Transplantation Network (OPTN) implemented MELD 3.0 to prioritize liver transplantation candidates aged 12 years and older |
| Chronic liver failure (CLIF) | It is a score used to predict mortality in patients with ACLF. There are several variants of this score considered accurate for assessing short-term and long-term mortality: CLIF-SOFA, CLIF-C ACLF, and CLIF-C AD scores. CLIF-SOFA is believed to excel in predicting mortality in ACLF patients, particularly in short-term assessments. This score assigns points ranging from 0 to 2 based on parameters such as bilirubin levels, creatinine levels, degree of hepatic encephalopathy, INR, MAP, and PaO2/FiO2 or SpO2/FiO2 |
| West Haven Criteria | Commonly used to assess the severity of HE, categorizing it as unimpaired, subclinical/minimal, grade 1, grade 2, grade 3, or grade 4 (indicating coma)Some experts argue that minimal HE and grade 1 should be classified as covert HE, while grades 2, 3, and 4 should be classified as overt HE |
| MELD – the model of end-stage liver disease; TIPS – transjugular intrahepatic portosystemic shunt; INR – International Normalized Ratio; CLIF – the chronic liver failure, SOFA – the Society of Opioid-Free Anesthesia, ACLF – acute-on-chronic liver failure; AD – acute decompensation; MIP – mean arterial pressure; HE – hepatic encephalopathy. | |