Anesth Prog. 2024 Sep 9;71(3):149-157. doi: 10.2344/616992.
Hepatic compromise poses significant impacts upon the care of patients undergoing routine dental treatment. When sedation or general anesthesia is planned for dental treatment or oral and maxillofacial surgery, an understanding of basic liver function and clinical evaluation can assist in adapting treatment modifications for patients with limited function due to previous disease and resultant organ transplantation efforts. Beginning with a basic overview of hepatic physiology, this review will outline the specific functions of digestion, metabolism, synthesis, and detoxification involving the liver. Specific clinical considerations will be reviewed regarding comorbidities that develop prior to and after liver transplantation that often impact a patient's suitability for ambulatory and office-based care. Lastly, choices in both local anesthetics, sedative medications, general anesthetics, and postoperative analgesics utilized in dental treatment will be discussed.
肝脏功能障碍对接受常规牙科治疗的患者的护理有重大影响。当计划对牙科治疗或口腔颌面外科进行镇静或全身麻醉时，了解基本的肝功能和临床评估可以帮助对因既往疾病和随后的器官移植而导致功能有限的患者进行治疗调整。本综述从肝脏生理学的基本概述开始，概述了涉及肝脏的消化、代谢、合成和解毒的特定功能。将回顾与肝移植前和肝移植后发生的合并症相关的具体临床注意事项，这些合并症常常影响患者是否适合门诊和办公室护理。最后，将讨论在牙科治疗中使用的局部麻醉剂、镇静药物、全身麻醉剂和术后镇痛药的选择。
