Purpose
To report a case of desflurane hepatotoxicity.
Abstract
Clinical features
An 81-yr-old woman with a remote history of abdominal surgery developed severe acute liver injury after general anesthesia with desflurane for resection of colonic cancer. Serum alanine aminotransferase and aspartate aminotransferase peaked at postoperative day six (2188 and 425 U·L-1 respectively), with the development of coagulopathy with an international normalized ratio of 2.29 on postoperative day eight, progressive jaundice with a peak serum total bilirubin of 214 μmol·L-1 on postoperative day 12 and hepatic encephalopathy on postoperative day ten. Other causes for liver disease were excluded. Treatment with corticosteroids was started. The liver biochemistry normalized completely by postoperative day 30 and the patient was discharged from hospital on postoperative day 21.
Conclusions
To our knowledge, this represents only the third report of desflurane hepatotoxicity and the first with reversible fulminant liver failure. Our experience suggests that all fluorinated anesthetics may cause acute hepatic damage.
Résumé
Objectif
Présenter un cas d’hépatotoxicité au desflurane.
Éléments cliniques
Une lésion hépatique aiguë sévère s’est développée chez une femme de 81 ans, déjà opérée à l’abdomen longtemps auparavant, à la suite d’une anesthésie générale avec du desflurane pour la résection d’un cancer du colon. L’alanine aminotransférase et l’aspartate aminotransférase sériques ont présenté des valeurs maximales au jour six après l’opération (2188 et 425 U·L-1 respectivement). Une coagulopathie selon un ratio international normalisé de 2,29 s’est développée au jour huit, un ictère progressif avec un taux maximal de bilirubine totale de 214 μmol·L-1 au jour 12 et une encéphalopathie hépatique au jour dix. D’autres causes de lésion hépatique ont été exclues. Un traitement aux corticostéroides a été amorcé. La biochimie hépatique s’est complètement normalisée au jour 30 et la patiente a quitté l’hopital au jour 21.
Conclusion
Nous croyons que c’est seulement le troisième cas documenté sur l’hépatotoxicité au desflurane et le premier à présenter une insuffisance hépatique fulminante réversible. Notre expérience laisse penser que tous les anesthésiques fluorés pourraient causer des atteintes hépatiques aiguës.
Article PDF
Similar content being viewed by others
References
Ray DC, Drummond GB. Halothane hepatitis. Br J Anaesth 1991; 67: 84–99.
Kenna JG, Jones RM. The organ toxicity of inhaled anesthetics. Anesth Analg 1995; 81(6 Suppl): S51–66.
Njoku D, Laster MJ, Gong DH, Eger EI II, Reed GF, Martin JL. Bio transformation of halothane, enflurane, isoflurane, and desflurane to trifluoroacetylated liver proteins: association between protein acylation and hepatic injury. Anesth Analg 1997; 4: 173–8.
Kenna JG, Satoh H, Christ DD, Pohl LR. Metabolic basis for a drug hypersensitivity: antibodies in sera from patients with halothane hepatitis recognize liver neoantigens that contain the trifluoroacetyl group derived from halothane. J Pharmacol Exp Ther 1988; 245: 1103–9.
Cohen EN, Trudell JR, Edmunds HN, Watson E. Urinary metabolites of halothane in man. Anesthesiology 1975; 43: 392–401.
Chase RE, Holaday DA, Fiserova-Bergerova V, Saidman LJ, Mack FE. The biotransformation of ethrane in man. Anesthesiology 1971; 35: 262–7.
Holaday DA, Fiserova-Bergerova V, Latto IP, Zumbiel MA. Resistance of isoflurane to biotransformation in man. Anesthesiology 1975; 43: 325–32.
Sutton TS, Koblin DD, Gruenke LD, et al. Fluoride metabolites after prolonged exposure of volunteers and patients to desflurane. Anesth Analg 1991; 73: 180–5.
Martin JL, Plevak DJ, Flannery KD, et al. Hepatotoxicity after desflurane anesthesia. Anesthesiology 1995; 83: 1125–9.
Bourdi M, Chen W, Peter RM, et al. Human cytochrome P450 2E1 is a major autoantigen associated with halothane hepatits. Chem Res Toxicol 1996; 9: 1159–66.
Gelman SI. Disturbances in hepatic blood flow during anesthesia and surgery. Arch Surg 1976; 111: 881–3.
Gitlin N, Serio KM. Ischemic hepatitis: widening horizons. Am J Gastroenterol 1992; 87: 831–6.
Seeto RK, Fenn B, Rockey DC. Ischemic hepatitis: clinical presentation and pathogenesis. Am J Med 2000; 109: 109–13.
Henrion J, Schapira M, Luwaert R, Colin L, Delannoy A, Heller FR. Hypoxic hepatitis: clinical and hemodynamic study in 142 consecutive cases. Medicine 2003; 82: 392–406.
Berghaus TM, Baron A, Geier A, Lamerz R, Paumgartner G. Hepatotoxicity following desflurane anesthesia (Letter). Hepatology 1999; 29: 613–4.
O’Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 1989; 97: 439–45.
Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 2002; 137: 947–54.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tung, D., Yoshida, E.M., Wang, C.S.K. et al. Severe desflurane hepatotoxicity after colon surgery in an elderly patient. Can J Anaesth 52, 133–136 (2005). https://doi.org/10.1007/BF03027717
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03027717