EditordAnaesthetic-induced hepatic dysfunction is a complex diagnostic problem. Because of the use of multiple drugs that can cause liver dysfunction, it is often difficult to pinpoint the culprit. Diagnosis of inhalation anaesthetic-related hepatic injury is usually made after other causes have been excluded. Unlike other drugs of this class, sevoflurane has the least hepatotoxic potential as it is not metabolised to reactive intermediates that lead to the formation of hepatotoxic proteins. 1 Using a case of acute hepatitis after general anaesthesia as an example, we review the mechanisms of liver injury and suggest measures to avoid recurrence. We obtained written consent from the patient for publication and have reported this adverse event to our hospital pharmacy and the US Food and Drug Administration.A 58-yr-old male with a BMI of 23.5 kg m À2 was undergoing L5-S1 laminectomy under general anaesthesia. His anaesthetic history was significant for acute hepatitis after two previous spine surgeries. In both cases, his postoperative course was marked by elevated liver enzymes accompanied by nausea and anorexia. His medical history was significant for hypertension, hyperlipidaemia, exercise-induced asthma, and Factor V Leiden. His medications included enalapril, atorvastatin, enoxaparin, warfarin, pregabalin, ibuprofen, tramadol, and paracetamol. He had no history of jaundice, blood transfusions, tattoo, high risk sexual activity, injected drug use, or alcohol use.He had previously received propofol, fentanyl, rocuronium, and sevoflurane for anaesthesia. He had been diagnosed as being allergic to propofol which had been incriminated as the offending agent during his previous admissions. Hence, we planned to use alternate anaesthetics such as etomidate for induction along with opioids and a neuromuscular blocking agent, with sevoflurane for maintenance.His preoperative evaluation was unremarkable with all investigations, including liver enzymes, within normal limits. Preoperative vital signs were normal. On the day of surgery,