system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
The dose of all of the following local anesthetic should be decreased in patients with deranged liver function except-
assistant
The correct answer is  procaine is the only amino ester local anesthetic. All Aminoester compounds are hydrolyzed by plasma cholinesterase (pseudocholinesterase or butyrylcholinesterase) except cocaine which is paially metabolized by hepatic carboxylesterase and paially excreted unexchanged in the urine. Amino Amide local anesthetics like lidocaine, bupivacaine, ropivacaine, prilocaine are metabolized (N-dealkylation and hydroxylation) by microsomal P-450 enzymes in the liver.