Adverse Outcomes of Anesthetic Interventions in Cirrhotic Patients: A Systematic Review

Abstract

Objectives: To assess and summarize the adverse outcomes associated with anesthetic interventions in cirrhotic patients. Methods: A total of 543 pertinent publications were found after a comprehensive search across four databases. 50 full-text publications were examined after duplicates were eliminated using Rayyan QCRI and relevance was checked; seven studies finally satisfied the requirements for inclusion. Results: We included seven studies with a total of 12,267patients, and more than half of them 6918 (56.4%) were females.This review highlights that remimazolam and propofol are safer anesthetic options for cirrhotic patients, reducing risks like hypotension, hypoxia, and prolonged recovery. In contrast, midazolam worsens encephalopathy and causes more hemodynamic instability. Rare complications, including hypoxia and cardiovascular events, were reported with benzodiazepines, narcotics, and general anesthesia. Tailored anesthetic strategies are essential to minimize risks in this high-risk population.Conclusion: Remimazolam and propofol are safer anesthetic options for cirrhotic patients, reducing hemodynamic and respiratory risks, while midazolam and general anesthesia pose higher risks, especially in advanced liver dysfunction. Individualized strategies, careful monitoring, and further research are essential to improving perioperative care in this vulnerable population.