[Clinical problems in the application of sedatives in patients with chronic liver disease (author's transl)]

In these introductory remarks the application of sedatives in patients with chronic liver diseases is discussed. Sedatives, for example, are used in agitated alcoholics with liver damage, as premedication before endoscopical examinations (emergency endoscopy for hemorrhage from the upper G.i.-tract, peritoneoscopy), and operations necessary for the treatment of typical complications of the liver disease (shunt-op. for portal hypertension). In all these situations the metabolism and pharmaco-kinetics of sedatives may be influenced by the liver disease in a non-predictable way. Generally, an enhanced, enforced and prolonged effect can be assumed. Long acting barbiturates are recommended for a long period treatment, diazepam in reduced doses is used as premedication for endoscopical examination. Opiates should be avoided.