Adequate analgesia is essential, and is best provided by a continuous infusion of alfentanil. Other opioids may be used, but the kinetics of morphine or fentanyl may be more difficult to predict in this population. It is best to avoid the use of hypnotic agents if the function of the new graft is uncertain; propofol infusions are least likely to cause delayed recovery of consciousness, but in large doses produce cardiovascular depression. Patients with prior fulminant hepatic failure will require neuromuscular blockade for at least 24 h, and atracurium or its isomer cisatracurium are the only relaxants which should be used in this patient population.
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