Clinical studies of liver function: I. The effect of anesthesia and certain surgical procedures

Abstract

The effect of certain anesthetics and various operative procedures on liver function was studied in eighty-four patients before and after operation, using the hippuric acid test as an index of hepatic function. All of the patients studied were considered good operative risks and were without evidence of functional liver insufficiency before operation. Spinal anesthesia produced the least evidence of hepatic dysfunction in twentyone patients subjected to a variety of operative procedures. In eighteen patients (85 per cent) liver function averaged 104 per cent before operation and 96 per cent on the first or second day after operation. In two patients in whom a transient fall in blood pressure occurred on the operating table, the postoperative hippuric acid tests fell to 74 and 49 per cent, respectively, and then returned to normal within seventeen days. Ether anesthesia produced transient subnormal hepatic function in all of sixteen patients. An average liver function of 101 per cent before operation was reduced to 67 per cent. By the end of one week normal values were again obtained. Avertin given as a basal anesthetic in combination with novocain infiltration reduced liver function by 5 to 30 per cent in seven patients. Amytal and morphine given as preoperative sedation to forty patients operated upon under novocain infiltrated locally produced no change in the functional state liver as reflected by the hippuric of the acid test.