Impact of Liver Disease on Use of Muscle Relaxants in Anesthesia: A Comprehensive Review.

Skeletal muscle relaxants have found wide application in anesthesiology. They are used during surgeries, to support mechanical ventilation, or as an aid for safe intubation. Their use is associated with the creation of a conduction block at the neuromuscular junction. To terminate the neuromuscular blockade or to prevent residual blockade, another group of drugs called reversal agents is used. These include drugs like neostigmine and sugammadex. Many factors may influence the duration and potency of skeletal muscle relaxants, including dysfunctions of organs such as the kidneys or liver. Liver damage can have various etiologies - it can be toxic drug-induced, or due to the ingestion of toxic substances, viral infections, or alcohol consumption. In recent years, there have been increasing reports on the impact of metabolic disorders on liver steatosis and damage. The liver is responsible for the metabolism of many drugs, the excretion of metabolites into bile, and protein production. Progressive liver damage can lead to its remodeling, and eventually to cirrhosis and failure. Liver dysfunction can be associated with numerous systemic complications. A decrease in protein synthesis causes a decrease in the binding of drugs to plasma proteins, a decrease in the volume of distribution, and an increased amount of free drug forms in the body. Liver failure can affect the metabolism of some skeletal muscle relaxants and neuromuscular blockade reversal agents. This article aims to review the role of muscle relaxants in anesthesia for patents with liver disease.