In a child with intestinal obstruction with deranged liver function test, the anesthetic of choice is :
**Core Concept**
The question is testing the knowledge of anesthetic management in a child with intestinal obstruction and deranged liver function tests. The underlying principle is the choice of anesthetic agent that minimizes hepatic metabolism and avoids exacerbating the liver dysfunction.
**Why the Correct Answer is Right**
In a child with intestinal obstruction and deranged liver function tests, the anesthetic of choice should be a drug that undergoes minimal hepatic metabolism to avoid further liver injury. Propofol is a suitable choice as it is metabolized in the liver but has a low liver extraction ratio, meaning it does not rely heavily on liver function for its clearance. Additionally, propofol has a rapid onset and offset of action, which is beneficial in a patient with intestinal obstruction who may be at risk of aspiration.
**Why Each Wrong Option is Incorrect**
**Option A:** Thiopentone is a barbiturate that undergoes significant hepatic metabolism, making it a poor choice in a patient with deranged liver function tests.
**Option B:** Ketamine can increase intracranial pressure and is not ideal for a child with intestinal obstruction who may be at risk of aspiration.
**Option C:** Fentanyl is an opioid that can cause respiratory depression and is not suitable for a child with intestinal obstruction who may have compromised respiratory function.
**Clinical Pearl / High-Yield Fact**
In pediatric anesthesia, it's essential to choose anesthetic agents that minimize hepatic metabolism to avoid exacerbating liver dysfunction. Propofol is a good choice in such cases due to its low liver extraction ratio and rapid onset and offset of action.
**Correct Answer:** C. Propofol is the anesthetic of choice in a child with intestinal obstruction and deranged liver function tests.