Viral hepatitis -: what the anaesthesiologist should know

Viral hepatitis is a major world-wide public health issue. An increasing number of virus carriers with acute or chronic hepatitis at all stages of the disease will be seen by an anaesthesiologist. A timely update of what anaesthetists should know about viral hepatitis was considered warranted. This update includes information on diagnostic aspects, the major clinical picture and course, and the treatment of acute and chronic viral hepatitis. Furthermore, anaesthetic implications and the prevention of nosocomial infections are described. Elective surgery should be postponed and any medications with the potential to harm the liver (e.g. volatile anaesthetics) should not be used in patients suspected of having acute viral hepatitis. A decrease in prothrombin time to below 50% (INR>1.75) is the first sign of acute severe liver failure. Extrahepatic manifestations of chronic hepatitis are likely to alter anaesthetic management. Titrated, balanced anaesthesia should be provided, and agents that are not eliminated by the liver should be preferred. Prophylactic guidelines addressing nosocomial hepatitis transmission should be respected. Elective surgery should be postponed and any medications with the potential to harm the liver (e.g. volatile anaesthetics) should not be used in patients suspected of having acute viral hepatitis. A decrease in prothrombin time to below 50% (INR > 11.75) is the first sign of acute severe liver failure. Extrahepatic manifestations of chronic hepatitis are likely to alter anaesthetic management. Titrated, balanced anaesthesia should be provided, and agents that are not eliminated by the liver should be preferred. Prophylactic guidelines addressing nosocomial hepatitis transmission should be respected.