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When compared with volatile anesthetics, less information is available regarding the impact of intravenous anesthetics on hepatic function. Early investigations suggested that etomidate and thiopental decreased hepatic blood flow, either from increased hepatic arterial vascular resistance or from reduced cardiac output and blood pressure,[37] whereas ketamine was shown to have little impact on hepatic blood flow, even at large doses.[38] With the use of sensitive radiolabeled microsphere determinations of organ blood flow in animals, propofol was found to increase THBF in both the hepatic arterial and portal venous circulation, thus suggesting a significant splanchnic vasodilator effect of propofol.[39] [40] THBF was maintained in some animal models even with significant reductions in MAP, [41] whereas others showed decreased mean hepatic blood flow despite increased MAP, a finding attributed to species-specific effects of propofol.[42] Limited human data suggest a more favorable splanchnic and hepatic oxygen delivery balance with propofol than with halothane.[43] Based on limited clinical and experimental data, it appears that intravenous anesthetics have only a modest impact on hepatic blood flow and no meaningful adverse influence on postoperative liver function when blood pressure is adequately maintained.
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