THE ANESTHETIC management of surgical patients with hepatic damage is difficult and perplexing, particularly from the standpoint of postoperative and postanesthetic morbidity. While it is generally recognized that damage to the liver produced by certain anesthetic agents is simply one manifestation of an over-all metabolic depression and largely preventable by adequate oxygenation, careful preoperative attention to the vitamin K level and the carbohydrate and nitrogen balance.1 the question of specific hepatotoxicity must still be considered. In this regard attention has been focused on the barbiturates, since some of these drugs are detoxified in the liver2 and have been known to produce prolonged toxicity in patients with damaged livers. Certain thiobarbiturates administered orally to animals over long periods have been shown by Kohn-Richards3 to cause hepatic damage. Since thiopental sodium (pentothal sodium®) is a thiobarbiturate and earlier reports indicated prolonged narcosis in the presence of hepatic disease,4
WALTON CH, UHL JW, EGNER WM, LIVINGSTONE HM. USE OF THIOPENTAL SODIUM INTRAVENOUSLY IN THE PRESENCE OF HEPATIC DAMAGE: An Experimental Study. Arch Surg. 1950;60(5):986–994. doi:10.1001/archsurg.1950.01250011009012
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