impact of general versus regional anaesthesia on portal pressure

Portal hypertension occurring during the natural course of liver cirrhosis is a consequence of the increased intrahepatic resistance to portal flow. Patients with liver disease carry a risk of peri-operative morbidity and mortality related to the extent of their liver dysfunction. In patients with compromised liver function preservation of the remaining function is essential; otherwise, peri-operative complications are high.The influence of volatile anesthetics on hepatic blood flow and function is complex and related not only to features unique to the anesthetic itself but also to other patient-related variables. Meanwhile, intravenous anesthetics have only a modest impact on hepatic blood flow and no meaningful adverse influence on postoperative liver function when arterial blood pressure is adequately maintained.The effect of spinal or epidural anesthesia on liver blood flow and hepatic function is not clearly an anesthetic drug-induced alteration in hepatic function. Early investigations showed that hepatic blood flow decreased during high spinal and epidural anesthesia and appeared to mirror simultaneous reductions in systemic arterial blood pressure..