. Author manuscript; available in PMC: 2021 Sep 29.

Published in final edited form as: Anesth Analg. 2021 Jul 1;133(1):80–92. doi: 10.1213/ANE.0000000000005433

Table 5:

Medications commonly used in anesthesia and their implications in liver dysfunction

Medication	Implications in liver dysfunction
Volatile anesthetic	Decreased hepatic blood flow
Nitrous oxide	Decreased hepatic blood flow Exacerbates pulmonary hypertension
Benzodiazepines	Highly protein bound Metabolized by the liver
Vecuronium and Rocuronium	Metabolized by the liver
Succinylcholine	Decreased pseudocholinesterase production (clinically only relevant in severe liver disease)
Sugammadex	Safely used in liver failure patients and obstetrics Renal failure patients may require higher doses¹⁵⁶
Amide local anesthetics	Metabolized by the liver Highly protein bound and may lead to supratherapeutic plasma levels
Ester local anesthetics	Decreased pseudocholinesterase production

For pharmacokinetic and pharmacodynamic changes of commonly used drugs in pregnancy and child birth, please refer to Ansari et al.¹⁵⁷