Selection of anesthetic agents for obstructive jaundice: An update for anesthesiologists

Obstructive jaundice is induced by complete or partial obstruction of the common bile duct, which causes bile to overflow from the digestive system into the circulatory system. Clinically, such patients often require surgical interventions to relieve obstructive jaundice, but the extensive and complex pathophysiological changes associated with obstructive jaundice not only lead to a higher incidence of perioperative morbidity and mortality, but also significantly affect the pharmacological properties of anesthetic agents, which poses a major challenge to anesthesia management. Therefore, this article reviews the research progress on the pharmacological properties of anesthesia in obstructive jaundice in the past 20 years, and focuses on the influence of obstructive jaundice on the pharmacodynamics and pharmacokinetics of inhaled anesthetics, intravenous anesthetics, opioid analgesics, and muscle relaxants commonly used in clinic. In fact, alterations in pharmacological properties of these anesthetic agents induced by obstructive jaundice vary widely. For example, patients with obstructive jaundice have increased sensitivities and decreased requirements to desflurane, etomidate, and rocuronium, while propofol and atracurium are almost not affected. In addition, the effects of these drugs on the functions of vital organs in jaundiced patients are also discussed in detail. Anesthesiologists should be aware of the importance of rational use of anesthetic agents in jaundiced patients during operation, and the selection of appropriate anesthetics on the basis of comprehensive evaluation and the precise adjustment of dosage based on strict intraoperative monitoring, are crucial to ensure the stability of anesthesia and reduce perioperative risks.