Table 45-8
- Opioids
- Metabolism is decreased and dosing intervals should be increased to avoid drug accumulation
- Remifentanil is an exception as its elimination is independent of hepatic function and duration of infusion
- May worsen encephalopathy
- Induction Drugs (Ketamine, Etomidate, Propofol)
- Despite high lipid solubility and high extraction ratios, the clearance is similar in patients with cirrhosis and normal patients
- Neuromuscular Blocking Drugs
- Prolonged duration of action of vecuronium and rocuronium
- Succinylcholine metabolism altered owing to reduced plasma cholinesterase activity, but clinical effect is rarely significant
- Vasopressors
- Decreased response to endogenous vasoconstrictors
- Hyporesponsiveness to catecholamines