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Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test01:22

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In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
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Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment01:08

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Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
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Local Anesthetics: Adverse Effects01:12

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While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
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Effect of Hepatic Disease on Pharmacokinetics: Active Drug, Metabolite and Fraction of Metabolized Drug01:14

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In pharmacotherapy, monitoring drug concentrations is paramount, especially for drugs whose therapeutic effects hinge on both the active compound and its metabolite. Hepatic impairment profoundly influences drug potency by altering liver function. If the drug is more potent than its metabolite, impaired liver function amplifies drug activity due to elevated drug concentration levels. Conversely, if the metabolite holds greater potency, diminished liver function diminishes drug activity by...
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Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
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Propofol-Induced Hepatitis.

Hanna Raisi1, Thomas Longerich2, Bernardo Moreira Assuncao1

  • 1Center for Alcohol Research (CAR), University of Heidelberg and Department of Medicine, Salem Medical Center, Heidelberg, Germany.

European Journal of Case Reports in Internal Medicine
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PubMed
Summary
This summary is machine-generated.

Propofol anesthesia can rarely cause acute hepatitis, even in patients without prior liver issues. Prompt treatment with steroids and N-acetyl cysteine led to recovery in this rare case of drug-induced liver injury.

Keywords:
Propofolanaesthesiahepatitis

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Area of Science:

  • Hepatology
  • Toxicology
  • Anesthesiology

Background:

  • Drug-induced liver injury (DILI) is a significant clinical concern.
  • Propofol, a widely used anesthetic, is generally considered safe but can rarely cause hepatotoxicity.
  • Identifying and managing rare adverse drug reactions is crucial for patient safety.

Purpose of the Study:

  • To report a rare case of acute hepatitis induced by propofol.
  • To highlight the diagnostic challenges and treatment outcomes for propofol-induced liver injury.
  • To emphasize the potential for severe liver damage from commonly used medications.

Main Methods:

  • Case presentation of a 59-year-old male with suspected toxic hepatitis post-propofol anesthesia.
  • Clinical evaluation including liver function tests, liver stiffness measurement, and liver biopsy.
  • Therapeutic intervention with corticosteroids and N-acetyl cysteine.

Main Results:

  • The patient presented with jaundice and elevated transaminases, indicative of liver necrosis.
  • Liver biopsy confirmed bridging necrosis and early fibrosis.
  • Clinical improvement and discharge on day seven following treatment with steroids and N-acetyl cysteine.

Conclusions:

  • Propofol can induce acute hepatitis, a rare but serious adverse effect.
  • Early recognition and treatment, particularly with steroids and N-acetyl cysteine, can reverse hepatic abnormalities.
  • This case underscores the importance of considering DILI even with agents perceived as safe.