Regional anesthesia may be useful in patients with:
A. Advanced liver diseaseRegional anesthesia may be useful in patients with advanced liver disease, assuming coagulation status is acceptable. When general anesthesia is selected, administration of modest doses of volatile anesthetics with or without nitrous oxide or fentanyl often is recommended. Selection of nondepolarizing muscle relaxants should consider clearance mechanisms for these drugs. For example, patients with hepatic cirrhosis may be hypersensitive to mivacurium because of the lowered plasma cholinesterase activity. Perfusion to the liver is maintained by administering fluids (guided by filling pressures) and maintaining adequate systemic pressure and cardiac output.