Hepatotoxicity after sevoflurane anaesthesia: a new twist to an old story

Abstract

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,

Association between well‐characterized gene polymorphisms and the hypnosis response caused by sevoflurane‐induced anaesthesia

“…To the best of our knowledge, this is the first prospective study to explore the association between gene polymorphisms and the sedation effect of sevoflurane in patients. Sevoflurane mainly functions as the original drug, and approximately 5% of sevoflurane is biotransformed by CYP2E1 to produce trifluoroacetyl chloride that can lead to drug‐induced liver injury 26 . In this study, CYP2E1 was not incorporated as a candidate gene.…”

Sevoflurane-Induced Thrombocytopenia in Post-Robotic-Assisted Paraesophageal Hernia Repair

“…The study did not show, however, significant change in platelet count, PTT, or PT immediately after anesthesia induction [ 8 ]. On the contrary, sevoflurane has previously demonstrated hepatotoxicity and reproducible hepatic dysfunction after anesthesia in patients with no prior history of liver disease [ 9 ]. Sevoflurane is a relatively safe drug in its class; however, its induction of compound A production may play a role in liver insults [ 9 ].…”

“…On the contrary, sevoflurane has previously demonstrated hepatotoxicity and reproducible hepatic dysfunction after anesthesia in patients with no prior history of liver disease [ 9 ]. Sevoflurane is a relatively safe drug in its class; however, its induction of compound A production may play a role in liver insults [ 9 ]. Additionally, repeated exposure to halogenated volatile anesthetics such as sevoflurane may cause drug sensitization further manifesting as hepatotoxicity [ 9 ].…”

“…Sevoflurane is a relatively safe drug in its class; however, its induction of compound A production may play a role in liver insults [ 9 ]. Additionally, repeated exposure to halogenated volatile anesthetics such as sevoflurane may cause drug sensitization further manifesting as hepatotoxicity [ 9 ].…”

Acute hepatic injury after prone surgery: was sevoflurane the cause? Comment on Br J Anaesth 2019; 122: e63–e71

“…This neurodegenerative disorder is characterised by progressive development of bradykinesia, resting tremor, and rigidity. 1 As the disease progresses, patients develop impaired performance of gross and fine motor skills. 2 A recent study showed that inspiratory muscle strength is also impaired, even in the very early stages of Parkinson's disease.…”