Final answer:
Patients with severe liver disease may require a decrease in the initial dose of neuromuscular blockers (NMB) due to impaired liver function. Monitoring liver function tests and the patient's response to NMB is essential.
Step-by-step explanation:
Dosing of Neuromuscular Blockers (NMB) in Severe Liver Disease
Patients with severe liver disease, such as cirrhosis, experience altered drug metabolism and elimination due to impaired liver function. As a result, the dosing requirements for medications, including neuromuscular blockers (NMB), may be affected.
In severe liver disease, the metabolism and elimination of NMB agents, such as rocuronium or vecuronium, can be prolonged leading to a higher risk of prolonged paralysis and drug accumulation. Therefore, a decrease in the initial dose of NMB may be necessary to minimize adverse effects.
It is essential to monitor the patient's response to NMB closely and adjust the dosage accordingly based on their liver function tests and the presence of any hepatic encephalopathy or hepatic coma.