.: DERLEME
COVID-19, Anesthesia and Liver: Traditional Review
COVID-19, Anestezi ve Karaciğer: Geleneksel Derleme
Turkiye Klinikleri J Anest Reanim. 2023;21(2):68-73
doi: 10.5336/anesthe.2022-94630
Makale Dili: EN
Tam Metin
ABSTRACT
In the coronavirus disease-2019 (COVID-19) pandemic, which started in 2019 and was caused by the severe acute respiratory syndrome-coronavirus-2 virus, the clinical course of the infection was observed in a wide range from very mild symptoms to death. Although the respiratory system and lungs are mostly affected in COVID-19 infection, other organs and systems are also affected. The most common symptoms in COVID-19 are fever, cough, fatigue, difficulty breathing, anosmia, and loss of taste. In cases where clinical symptoms are more severe, acute respiratory distress syndrome, cytokine storms, multiple organ failure, sepsis and thrombosis are seen. Liver involvement has an important place in the course of COVID-19 apart from lung involvement, some patients with COVID-19 infection and cooperation difficulties require general anesthesia during computed tomography imaging procedures or intensive care treatments. Again, the need for urgent surgical intervention during infection causes them to be exposed to general anesthetics. The negative effects of general anesthesia agents on organ systems, especially on the liver, is an important issue that is frequently emphasized in the literature. Liver enzymes should be monitored in the clinical follow-up and estimation of mortality in patients with a diagnosis of COVID-19. Non-emergency surgeries of patients with a diagnosis of COVID-19 should be postponed or if anesthesia applications are necessary, non-hepatotoxic or minimally hepatotoxic methods should be performed. In this review, it is aimed to share information on anesthesia applications in terms of COVID-19 and liver functions by examining the relationship of COVID-19 with the liver.
Keywords: COVID-19; anesthesia; liver
In the coronavirus disease-2019 (COVID-19) pandemic, which started in 2019 and was caused by the severe acute respiratory syndrome-coronavirus-2 virus, the clinical course of the infection was observed in a wide range from very mild symptoms to death. Although the respiratory system and lungs are mostly affected in COVID-19 infection, other organs and systems are also affected. The most common symptoms in COVID-19 are fever, cough, fatigue, difficulty breathing, anosmia, and loss of taste. In cases where clinical symptoms are more severe, acute respiratory distress syndrome, cytokine storms, multiple organ failure, sepsis and thrombosis are seen. Liver involvement has an important place in the course of COVID-19 apart from lung involvement, some patients with COVID-19 infection and cooperation difficulties require general anesthesia during computed tomography imaging procedures or intensive care treatments. Again, the need for urgent surgical intervention during infection causes them to be exposed to general anesthetics. The negative effects of general anesthesia agents on organ systems, especially on the liver, is an important issue that is frequently emphasized in the literature. Liver enzymes should be monitored in the clinical follow-up and estimation of mortality in patients with a diagnosis of COVID-19. Non-emergency surgeries of patients with a diagnosis of COVID-19 should be postponed or if anesthesia applications are necessary, non-hepatotoxic or minimally hepatotoxic methods should be performed. In this review, it is aimed to share information on anesthesia applications in terms of COVID-19 and liver functions by examining the relationship of COVID-19 with the liver.
Keywords: COVID-19; anesthesia; liver
ÖZET
2019 yılında başlayan, şiddetli akut solunum sendromu-koronavirüs-2 virüsünün etken olduğu koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] pandemisinde, enfeksiyonun klinik seyri çok hafif belirtilerden ölüme varan geniş bir yelpazede izlenmiştir. COVID-19 enfeksiyonunda daha çok solunum sistemi ve akciğerler etkilenmekle birlikte, diğer organ ve sistemler de etkilenmektedir. COVID-19'da en sık görülen semptomlar ateş, öksürük, yorgunluk, nefes almakta zorluk, anosmi ve tat alma duyusunda kayıptır. Klinik belirtilerin daha ağır seyrettiği olgularda ise akut solunum sıkıntısı sendromu, sitokin fırtınaları, çoklu organ yetersizliği, sepsis ve trombozlar görülmektedir. COVID-19 seyrinde solunum sistemi ve akciğer dışı organ hasarlarında karaciğer tutulumu önemli bir yer tutmaktadır. COVID-19 enfeksiyonu geçiren ve uyum sorunu olan bazı hastalara bilgisayarlı tomografi görüntüleme işlemleri ya da yoğun bakım tedavileri sırasında genel anestezi uygulamaları gerekmektedir. Yine enfeksiyon sırasında acil cerrahi müdahale gerekmesi genel anesteziklere maruz kalmalarına neden olmaktadır. Genel anestezi ajanlarının organ sistemleri üzerine, özellikle de karaciğer üzerine olumsuz etkileri literatürde sıklıkla vurgulanan önemli bir konudur. COVID-19 tanılı hastaların klinik takibinde ve mortalite tahmininde karaciğer enzimleri izlenmelidir. COVID-19 tanılı hastaların acil olmayan cerrahileri ertelenmeli, anestezi uygulamaları hepatotoksik olmayan ya da en az hepatotoksik olan yöntemlerle yapılmalıdır. Bu derlemede, COVID-19'un karaciğer ile ilişkisi irdelenerek, COVID-19 ve karaciğer fonksiyonları açısından anestezi uygulamaları konusunda bilgi paylaşılması amaçlanmıştır.
Anahtar Kelimeler: COVID-19; anestezi; karaciğer
2019 yılında başlayan, şiddetli akut solunum sendromu-koronavirüs-2 virüsünün etken olduğu koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] pandemisinde, enfeksiyonun klinik seyri çok hafif belirtilerden ölüme varan geniş bir yelpazede izlenmiştir. COVID-19 enfeksiyonunda daha çok solunum sistemi ve akciğerler etkilenmekle birlikte, diğer organ ve sistemler de etkilenmektedir. COVID-19'da en sık görülen semptomlar ateş, öksürük, yorgunluk, nefes almakta zorluk, anosmi ve tat alma duyusunda kayıptır. Klinik belirtilerin daha ağır seyrettiği olgularda ise akut solunum sıkıntısı sendromu, sitokin fırtınaları, çoklu organ yetersizliği, sepsis ve trombozlar görülmektedir. COVID-19 seyrinde solunum sistemi ve akciğer dışı organ hasarlarında karaciğer tutulumu önemli bir yer tutmaktadır. COVID-19 enfeksiyonu geçiren ve uyum sorunu olan bazı hastalara bilgisayarlı tomografi görüntüleme işlemleri ya da yoğun bakım tedavileri sırasında genel anestezi uygulamaları gerekmektedir. Yine enfeksiyon sırasında acil cerrahi müdahale gerekmesi genel anesteziklere maruz kalmalarına neden olmaktadır. Genel anestezi ajanlarının organ sistemleri üzerine, özellikle de karaciğer üzerine olumsuz etkileri literatürde sıklıkla vurgulanan önemli bir konudur. COVID-19 tanılı hastaların klinik takibinde ve mortalite tahmininde karaciğer enzimleri izlenmelidir. COVID-19 tanılı hastaların acil olmayan cerrahileri ertelenmeli, anestezi uygulamaları hepatotoksik olmayan ya da en az hepatotoksik olan yöntemlerle yapılmalıdır. Bu derlemede, COVID-19'un karaciğer ile ilişkisi irdelenerek, COVID-19 ve karaciğer fonksiyonları açısından anestezi uygulamaları konusunda bilgi paylaşılması amaçlanmıştır.
Anahtar Kelimeler: COVID-19; anestezi; karaciğer
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