Liver disease presents complex challenges in anesthesia due to impaired drug metabolism, coagulation abnormalities, altered glucose regulation, and increased susceptibility to infection and bleeding. Patients with chronic liver disease, cirrhosis, or acute hepatic dysfunction are at significantly higher risk of perioperative complications, making careful anesthesia planning essential.

The liver is central to the metabolism of many anesthetic agents. Impaired hepatic function can prolong drug effects, increase sensitivity to sedatives, and heighten the risk of postoperative confusion or delayed recovery. Coagulation disorders associated with liver disease increase bleeding risk during surgery and regional anesthesia procedures.

Pre-anesthesia evaluation focuses on assessing liver function, coagulation profile, presence of ascites, encephalopathy, and portal hypertension. Severity scoring systems help stratify risk and guide perioperative decision-making. Optimization may involve correcting coagulopathy, managing fluid status, and treating encephalopathy before surgery.

Intraoperative anesthesia management emphasizes stable hemodynamics, avoidance of hepatotoxic drugs, and careful monitoring of blood loss. Fluid management is particularly challenging due to altered vascular tone and third-space fluid shifts.

Postoperatively, patients with liver disease require close observation for bleeding, infection, hepatic decompensation, and altered mental status. Pain management is carefully tailored to avoid medications that worsen liver dysfunction.

Through individualized care and multidisciplinary coordination, anesthesia teams play a vital role in enabling safe surgery for patients with liver disease.