Li Yi-Qing, Zhou Xuefei, Cao Yunfei, Long Yue
Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China.
Department of Anesthesiology, Beilun District People's Hospital of Ningbo, Ningbo, China.
Medicine (Baltimore). 2025 Jun 27;104(26):e43074. doi: 10.1097/MD.0000000000043074.
Obstructive jaundice is induced by complete or partial obstruction of the common bile duct, which causes bile to overflow from the digestive system into the circulatory system. Clinically, such patients often require surgical interventions to relieve obstructive jaundice, but the extensive and complex pathophysiological changes associated with obstructive jaundice not only lead to a higher incidence of perioperative morbidity and mortality, but also significantly affect the pharmacological properties of anesthetic agents, which poses a major challenge to anesthesia management. Therefore, this article reviews the research progress on the pharmacological properties of anesthesia in obstructive jaundice in the past 20 years, and focuses on the influence of obstructive jaundice on the pharmacodynamics and pharmacokinetics of inhaled anesthetics, intravenous anesthetics, opioid analgesics, and muscle relaxants commonly used in clinic. In fact, alterations in pharmacological properties of these anesthetic agents induced by obstructive jaundice vary widely. For example, patients with obstructive jaundice have increased sensitivities and decreased requirements to desflurane, etomidate, and rocuronium, while propofol and atracurium are almost not affected. In addition, the effects of these drugs on the functions of vital organs in jaundiced patients are also discussed in detail. Anesthesiologists should be aware of the importance of rational use of anesthetic agents in jaundiced patients during operation, and the selection of appropriate anesthetics on the basis of comprehensive evaluation and the precise adjustment of dosage based on strict intraoperative monitoring, are crucial to ensure the stability of anesthesia and reduce perioperative risks.
梗阻性黄疸是由胆总管完全或部分梗阻引起的，这会导致胆汁从消化系统溢入循环系统。临床上，此类患者常需手术干预以缓解梗阻性黄疸，但与梗阻性黄疸相关的广泛而复杂的病理生理变化不仅导致围手术期发病率和死亡率升高，还会显著影响麻醉药物的药理特性，这给麻醉管理带来了重大挑战。因此，本文综述了过去20年梗阻性黄疸麻醉药理特性的研究进展，重点关注梗阻性黄疸对临床常用吸入麻醉药、静脉麻醉药、阿片类镇痛药和肌肉松弛药的药效学和药代动力学的影响。事实上，梗阻性黄疸引起的这些麻醉药物药理特性的改变差异很大。例如，梗阻性黄疸患者对地氟烷、依托咪酯和罗库溴铵的敏感性增加而需求量减少，而丙泊酚和阿曲库铵几乎不受影响。此外，还详细讨论了这些药物对黄疸患者重要器官功能的影响。麻醉医生应意识到术中合理使用麻醉药物对黄疸患者的重要性，基于全面评估选择合适的麻醉药并根据严格的术中监测精确调整剂量，对于确保麻醉稳定和降低围手术期风险至关重要。
