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CPD article: Sedation and general anaesthesia of the portosystemic shunt patient

02 May 2021
17 mins read
Volume 26 · Issue 5

Abstract

Sedation and general anaesthesia may be required in animals with confirmed or suspected portosystemic shunt for a variety of reasons, not limited to shunt attenuation, such as diagnostic, routine or emergency procedures. Veterinary surgeons should understand normal hepatic functions and processes in order to appreciate the implications of portosystemic shunts associated specifically with sedation and anaesthesia. The pathophysiological and physiological variations, and their effects on anaesthesia and sedation, are discussed, as is management of the peri-anaesthetic period, drug choice for sedation or premedication, induction and maintenance of anaesthesia and analgesia. Patient monitoring and problem solving are also discussed, in relation to situations commonly encountered in portosystemic shunt patients during anaesthesia and sedation.

The liver is a multifunctional organ and accounts for 1.5–4% of total body mass (Garcia-Pereira, 2015). The liver receives approximately 25% of cardiac output (Self, 2016). The hepatic artery accounts for 30% of hepatic blood flow and 70% of the portal vein flow (Self, 2016). Portal venous blood provides 50-60% of the liver's oxygen supply (Self, 2016). It has a high capacity for autoregulation of blood flow and oxygen delivery (Lautt et al, 1985). A reduction in hepatic portal vein pressure is accompanied by hepatic arteriole dilation (Kock et al, 1972; Lautt et al, 1985), ensuring adequate blood and oxygen delivery (Mathie and Blumgart, 1983; Rocheleau et al, 1999).

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