OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Andreas HoeftAnaesthesia in patients with liver diseaseStarczewska, Malgorzata H.a; Mon, Wintb; Shirley, PeteraAuthor Information aAdult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust bUniversity College London Hospitals NHS Foundation Trust, London, United Kingdom Correspondence to Peter Shirley, Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, UK. Tel: +44 0203 594 0345; fax: +44 203 594 0347; e-mail: [email protected] Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-anesthesiology.com). Current Opinion in Anaesthesiology: June 2017 - Volume 30 - Issue 3 - p 392-398 doi: 10.1097/ACO.0000000000000470 Buy SDC Metrics Abstract Purpose of review The purpose of this review is to summarize the most recent up to date research data and recommendations regarding anaesthetic management of patients with liver disease undergoing surgery. The incidence of chronic liver disease (CLD) continues to rise and perioperative mortality and morbidity remains unacceptably high in this group. Meticulous preoperative assessment and carefully planned anaesthetic management are vital in improving outcomes in patients with liver disease undergoing surgery. Recent findings The presence of cirrhosis is associated with a significantly increased risk of postoperative morbidity and mortality in patients undergoing elective surgery. The Child--Pugh--Turcotte scale and model for end-stage liver disease (MELD) score remain the most commonly applied scoring systems in preoperative risk assessment, but new MELD-based indices and novel scoring systems might offer better prognostic value. Propofol and new inhalational agents (sevoflurane, desflurane) are recommended hypnotic agents. The titration of opiates in the perioperative period is recommended because of their altered metabolism in patients with liver disease. Perioperative management should include close haemodynamic monitoring and admission to a critical care area should be considered. Summary Patients with liver disease undergoing anaesthesia pose significant challenges and advanced planning and preparation are required in order to improve perioperative outcomes in this group. https://links.lww.com/COAN/A43. Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.