Post—operative hepatic morbidity with special reference to the role of halothane*

A Review of the Pharmacology of Halothane

“…Since there is no specific diagnostic test for this disease, it can never be confidently excluded. Indeed Vickers and Dinnick (1965) point out that the number of reported instances of jaundice after halothane anaesthesia is well within a conservative estimate of a number of cases of infective hepatitis which might have been expected to occur by chance. Morris and Feldman (1963) showed that hypotension and carbon dioxide retention during halothane anaesthesia have a most adverse effect on liver function, presumably because in both these conditions there is an increased splanchnic resistance with consequent reduced hepatic blood flow.…”

“…Initial experimental studies suggested that upsets of liver function in experimental animals were no more frequent with halothane than with other anaesthetics (Ravent6s, 1956;Krantz et al, 1958;Virtue et al, 1958). Indeed Jones, Margolis and Stephen (1958) found that halothane given by stomach tube to mice was much less toxic than chloroform or divinyl ether.…”

“…In the light of the present state of our knowledge it is not possible to establish a definite cause and effect relationship between halothane anaesthesia and postoperative liver damage. We have seen that there are many complicating factors, and several cases in which halodiane was originally incriminated were subsequently found to be due to other causes (Vickers and Dinnick, 1965). In attempts to clarify the position several clinical investigations, both retrospective and prospective, are now in progress or have been completed.…”

Serum enzyme changes after major lung surgery--with and without halothane

“…There were no differences between the two groups of cases. It seemed possible that the rises in SGOT and LDH which occurred quite frequently were an indication that tissue autolysis was occurring in the body.Retrospective statistical studies have largely discounted the risk of the development of massive hepatic necrosis as a complication of halothane anaesthesia (National Halothane Study, 1966;Mushin, Rosen, Bowen, and Campbell, 1964;Vickers and Dinnick, 1965;Henderson and Gordon, 1964). This form of investigation, however, involves a collection of data from a large number of sources with the inevitable accompanying variability in the material.…”