A patient with Child-Pugh class B cirrhosis requires anaesthesia for a non-hepatic elective procedure. Which agent is MOST appropriate for induction and maintenance to minimise hepatotoxic risk?
- A Halothane for smooth maintenance
- B Thiopentone induction with isoflurane maintenance
- C Propofol induction with sevoflurane or desflurane maintenance ✓
- D Ketamine induction with enflurane maintenance
Explanation
Halothane causes immune-mediated hepatitis (halothane hepatitis) and is absolutely contraindicated in liver disease. Enflurane produces more trifluoroacetylated metabolites than sevoflurane/desflurane and also carries hepatotoxic risk. Propofol undergoes hepatic conjugation but in standard doses does not cause hepatotoxicity; sevoflurane and desflurane produce minimal hepatically-metabolised fluorinated metabolites (2–5% for sevoflurane, <0.1% for desflurane) and are preferred. Thiopentone has prolonged action in cirrhosis due to reduced protein binding and metabolism.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.