BUMC Basics.pdf - Anesthesia Home

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the liver transplant ICU) where the nurses are very
comfortable taking care of liver patients.
▪ Transplant candidacy vs evaluation.
▪ If intubated in the ICU, propofol is usually your sedative
of choice.
▪ Levophed is in general your pressor of choice.
▪ If Tylenol is on your differential, always give at least one
dose of Acetadote- (acetylcysteine) which can be given
orally or IV until the Tylenol level comes back.
Alcoholic hepatitis
▪ Always calculate the discriminant function and consider
steroids or Trental if >32
▪ No steroids if any sign of infection
▪ Give folate 2 mg daily and thiamine 100 mg daily
▪ Nutrition is very important. Always consider tube feeds
(at least for a couple of days) if the patient does not have
good PO intake.
▪ Withdrawal precautions: Oxazepam preferred over other
benzodiazepines for withdrawal. Librium is very longacting
and can be problematic. Consider non-selective
beta-blockers as well, if the patient is hyperadrenergic
(hypertensive, tachycardic)
▪ Vitamin repletion: Always give thiamine before any
dextrose containing IV fluids. Because of malnourishment,
alcoholics often have thiamine, folate, and magnesium
deficiencies. Suggested orders: Add to first bag of IV
fluids daily (aka the “banana bag”) Thiamine 100 mg,
Folate 2 mg, one vial of multivitamins. Okay to follow Mg
levels or give 1-2 grams of Magnesium sulfate IV daily for
the first day or two. Watch Phosphate levels for refeeding
syndrome.
▪ High mortality
Decompensated Cirrhosis
When managing cirrhotics, mention patients Child’s Class or
MELD score (MELD score if preferable if pt is a transplant
candidate or is on the transplant list). Also mention underlying
cause if known (Laennec's cirrhosis, etc)
Hepatic encephalopathy
Stages of encephalopathy: The simplest assessment system
(most commonly used) grades HE as stages 1 to 4. The
grading is based upon changes in consciousness.