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El Aidouni G, Merbouh M, Lazreg M, Kachmar S, Laaribi I, Bouchlarhem A, Chatar MCE, Lamzouri O, Bkiyar H, Housni B. Severe hepatic impairment after sevoflurane anesthesia in a 10-month-old child: Case report. Ann Med Surg (Lond) 2021; 70:102915. [PMID: 34691439 PMCID: PMC8519796 DOI: 10.1016/j.amsu.2021.102915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 10/29/2022] Open
Abstract
Introduction Like other halogenated agents, sevoflurane can potentially cause a toxic reaction including severe hepatic failure which can lead to the death of the patient. However, Halogen immuno-allergic hepatitis is a very rare complication of anesthesia. We reported a 10 months' child who presented a severe hepatic injury after sevoflurane exposure. Case management A 10-month-old child was scheduled for acute intussusception anesthesia, induction was done with sevoflurane and propofol while maintenance of anesthesia was provided by sevoflurane alone. Three days after the operation, he was developed jaundice and altered general condition. A dramatic increase in liver enzymes was observed. The evolution was marked by an alteration of his consciousness and his hemodynamic state, he was intubated. Without improvement, the patient died on the 4th postoperative day. The autopsy was refused by the family. Conclusion These results underscore the need findings for a global and comprehensive understanding of the potential hepatotoxicity of exposure to volatile anesthetics including sevoflurane in infants and its long-term side effects which can be fatal.
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Affiliation(s)
- Ghizlane El Aidouni
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.,Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Manal Merbouh
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.,Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Moussa Lazreg
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.,Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Safae Kachmar
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.,Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Ilyass Laaribi
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.,Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Amine Bouchlarhem
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.,Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Mohammed Charaf-Eddine Chatar
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.,Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Oussama Lamzouri
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.,Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Houssam Bkiyar
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.,Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Brahim Housni
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.,Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Morocco.,Mohammed First University Oujda, FMP Oujda, LAMCESM, Oujda, Morocco
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Cho YJ, Park YJ, Min SH, Ryu HG. The Effect of General Anesthesia on Aminotransferase Levels in Patients with Elevated Aminotransferase Levels: A Single-Center 5-Year Retrospective Study. Anesth Analg 2015; 121:1529-33. [PMID: 26496369 DOI: 10.1213/ane.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The effect of commonly used anesthetics on postoperative aminotransferase levels in patients with preoperatively elevated values is unclear. METHODS The medical records of 25,567 adult patients undergoing elective general anesthesia were retrospectively reviewed. Patients were classified into normal (≤ 40 IU/L), mild (41-119 IU/L), moderate (120-199 IU/L), and marked elevation (200+ IU/L) groups according to their preoperative alanine aminotransferase levels. Changes in these levels before and after general anesthesia were compared according to the anesthetics used. RESULTS Among the patients with preoperative mild or moderate elevation, 97.8% (2589/2647) did not show a higher alanine aminotransferase level after surgery. Compared with total IV anesthesia (TIVA), sevoflurane showed adjusted odds ratios (95% confidence interval) of 1.27 (1.10-1.46) for mild, 1.33 (0.86-2.05) for moderate, and 3.35 (1.58-7.04) for marked postoperatively elevated levels of alanine aminotransferase versus normal levels. Similarly, compared with TIVA, desflurane showed adjusted odds ratios (95% confidence interval) of 1.21 (0.96-1.53) for mild, 1.44 (0.70-2.94) for moderate, and 3.18 (1.14-8.89) for marked postoperatively elevated levels of alanine aminotransferase versus normal levels (P = 0.05). CONCLUSIONS In most cases, postoperative alanine aminotransferase levels did not worsen even in patients with preoperatively elevated levels. Sevoflurane was associated with increased odds for postoperative elevation of these levels after general surgery compared with TIVA.
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Affiliation(s)
- Youn Joung Cho
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
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Sevoflurane hepatotoxicity: a case report of sevoflurane hepatic necrosis and review of the literature. Am J Ther 2010; 17:219-22. [PMID: 19455019 DOI: 10.1097/mjt.0b013e318197eacb] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Sevoflurane, a halogenated anesthetic, is associated with mild aminotransferase elevations but does not tend to cause clinically significant hepatotoxicity. We report a rare case of severe hepatic necrosis following exposure to sevoflurane during surgery. A 37-year-old man presented with nausea,vomiting, abdominal pain, and jaundice on the third postoperative day after an abdominal wall mass resection. Laboratory tests showed markedly elevated aminotransferase levels, hyperbilirubinemia, and coagulopathy. His viral hepatitis and human immunodeficiency virus (HIV) serologies were negative for acute infection, and his Epstein-Barr virus (EBV) and cytomegalovirus (CMV) serologies were suggestive of recent EBV infection and remote CMV infection. Antinuclear antibody and anti-smooth muscle antibody screens were negative. Ceruloplasmin and serum copper values were in the normal range. The histopathological findings included an acute centrilobular cholestatic hepatocellular injury compatible with the clinical history of acute drug-induced hepatotoxicity. The patient improved with conservative management. Unlike other halogenated anesthetics, proposed mechanisms of sevoflurane hepatotoxicity include production of compound A, increased cytosolic free Ca(2+), and activation of free radical metabolizing enzymes. The patient was likely susceptible to toxicity due to an underlying EBV infection and a probable history of exposure to halogenated anesthetics. Sevoflurane is generally considered to be relatively safe for subjects with mild liver dysfunction, in comparison with other halogenated anesthetics. However, this case suggests that sevoflurane can lead to severe life-threatening hepatic necrosis in at-risk individuals.
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Abstract
Sevoflurane is a widely used halogenated inhalation anaesthetic. In comparison with other similar anaesthetics, it is not metabolized to potentially hepatotoxic trifluoroacetylated proteins. In this case report, we present a 66-year-old woman with breast carcinoma, who underwent sevoflurane general anaesthesia twice in 25 days. Soon after the second elective surgical procedure, jaundice and marked elevations in serum transaminases developed. The patient died 66 days thereafter. Autopsy results denied evidence of major cardiovascular abnormality, and histological examination confirmed massive liver cell necrosis with no feature of chronic liver injury. Sevoflurane anaesthesia was imputed as the cause after exclusion of other possible aetiological agents. Besides, coexistent malignant tumours found in the patient could have modulated the immunological response to the applied anaesthetic followed by fatal consequences.
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Lehmann A, Neher M, Kiessling AH, Isgro F, Koloska A, Boldt J. Case report: Fatal hepatic failure after aortic valve replacement and sevoflurane exposure. Can J Anaesth 2007; 54:917-21. [DOI: 10.1007/bf03026797] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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