Anesthesia for the Patient with Concomitant Hepatic and Renal Impairment

Anesthesiol Clin. 2016 Dec;34(4):645-658. doi: 10.1016/j.anclin.2016.06.002.


Hepatic and renal disease are common comorbidities in patients presenting for intermediate- and high-risk surgery. With the evolution of perioperative medicine, anesthesiologists are encountering more patients who have significant hepatic and renal disease, both acute and chronic in nature. It is important that anesthesiologists have an in-depth understanding of the physiologic derangements seen with hepatic and renal disease to evaluate and manage these patients appropriately. Perioperative management requires an understanding of the physiologic perturbations associated with each disease process. This article elucidates the goals in the management and treatment of this complex patient population.

Keywords: Acute versus chronic hepatic failure; Acute versus chronic renal failure; Intraoperative organ protection; Liver and kidney transplantation; Model for end-stage liver disease; RIFLE criteria.

Publication types

  • Review

MeSH terms

  • Anesthesia / methods*
  • Humans
  • Kidney Diseases / complications*
  • Kidney Diseases / physiopathology
  • Kidney Diseases / therapy
  • Liver Diseases / complications*
  • Liver Diseases / physiopathology
  • Liver Diseases / therapy
  • Preoperative Care
  • Self Care