What anaesthetists need to know about viral hepatitis

Viral hepatitis is a major world-wide public health issue. An increasing number of virus hepatitis carriers with acute or chronic hepatitis at all stages of the disease will be referred to anaesthetists. An update of what anaesthetists should know about viral hepatitis was believed to be warranted.

The present review focuses on (a) diagnosis criteria and main biological and clinical patterns of acute and chronic hepatitis, and (b) extrahepatic manifestations, and adverse effects resulting from specific drug therapy likely to influence anaesthetic care.

Elective surgery should be postponed and any medications that could be harmful to the liver should be disregarded in patients suspected of having acute viral hepatitis. A prothrombin time decrease to less than 50% (INR > 1.75) is the first sign of acute severe liver failure. Extrahepatic manifestations resulting mainly from small- and medium-sized vessel alteration, and adverse effects caused by specific drug therapy are associated with chronic viral hepatitis and are likely to alter anaesthetic care. A titrated anaesthesia should be provided and agents not eliminated by the liver should be favoured. Vasopressor therapy should be administered early to control a systemic intraoperative blood pressure decrease associated with a high cardiac output. Prophylactic antibiotics should take into consideration the risk of translocation of gut bacteria to the systemic circulation. Prophylactic guidelines of hepatitis nosocomial transmission should be respected.

Anaesthetists are likely to play a key role in immediate acute hepatitis and chronic hepatitis perioperative assessment and care.