Anaesthetic Management of Patient With Gilbert’s Syndrome

Abstract

Gilbert's syndrome is characterized by mild unconjugated hyperbilirubinemia without either structural liver disease or hemolytic anemia. Bilirubin is produced during the breakdown of hemoglobin and hemoproteins. Since bilirubin is insoluble in water, it must be converted into a soluble conjugate form in the liver before elimination from the body. In the liver, enzyme uridine diphosphate (UDP) glucoronosyltransferase converts the bilirubin into the mixture of monoglucoronides and diglucoronides referred as conjugated bilirubin. The relative deficiency of UDP glucoronosyltransferase results in reduced activity nearly 10-30% normal, leading to unconjugated hyperbilirubinemia, Gilbert's Syndrome (GS). Since majority of anesthetic agents require this enzyme for their metabolism and excretion, its deficiency leads to potential accumulation of such drugs resulting in anesthetic toxicity with adverse outcome. Anesthetic management of Patient with Gilbert's Syndrome is quite challenging. A thorough knowledge of pathophysiology and precipitating factors of GS are essential for safe administration of anesthesia.

Perioperative management and anaesthetic considerations for adult patients with Gilbert’s syndrome and oral cancer: review and case report

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Manajemen Anestesi Pasien Pascainfeksi Polio yang Menjalani Operasi Seksio Sesarea

“…Banyak ahli anestesi ragu-ragu untuk memberikan anestesi regional pada pasien dengan gangguan neuromuskular yang sudah ada sebelumnya karena kekhawatiran tentang memperburuk penyakit yang ada atau kesulitan mengevaluasi komplikasi. 11,13,14 Dalam berbagai literatur, anestesi regional selalu menjadi pilihan utama untuk pasien PPS dibandingkan dengan anestesi umum. Penggunaan anestesi neuraksial pada pasien dengan gangguan neuromuskular sebelumnya dihindari karena risiko yang tidak diketahui dan potensi memburuknya gejala.…”

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“…The subsequent metabolism does not occur by conjugation but by dealkylation and dehydroxylation. [ 5 ] Remifentanil is safe as it undergoes quick metabolism by plasma and tissue esterases. The effect of morphine is prolonged as it is metabolized by conjugation in the liver.…”