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Aghnatios L, Karsenty C, Viard C, de Canecaude C, Durrieu G. Severe hepatitis after sevoflurane anesthesia in an 8-month old child with a Down syndrome: Case report and review of the literature. Therapie 2023; 78:459-462. [PMID: 36404159 DOI: 10.1016/j.therap.2022.10.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Lucas Aghnatios
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Centre Régional de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CHU, 31000 Toulouse, France
| | - Clément Karsenty
- Pediatric Cardiology Unit, Children's Hospital, CHU Toulouse, France; Institut Des Maladies Métaboliques Et Cardiovasculaires, Université de Toulouse, INSERM U1048, I2MC, Toulouse, France
| | - Caroline Viard
- Pediatric Pharmacy, Children's Hospital, CHU Toulouse, Université de Toulouse, France
| | - Claire de Canecaude
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Centre Régional de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CHU, 31000 Toulouse, France
| | - Geneviève Durrieu
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Centre Régional de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CHU, 31000 Toulouse, France.
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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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3
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Bermúdez Barrezueta L, Benito Gutiérrez M, Martínez Rafael B, Herraiz Cristóbal R, Pino Vázquez A. Acute liver failure after sevoflurane anesthesia in a pediatric patient. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2019; 66:474-477. [PMID: 31427144 DOI: 10.1016/j.redar.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 06/10/2023]
Abstract
Sevoflurane is a volatile anesthetic characterized by low toxicity and is the most used in pediatric age. Unlike other halogenated anesthetic, sevoflurane is not metabolized to reactive intermediates that lead to the formation of hepatotoxic proteins. However, a few cases of hepatotoxicity have been associated with its use. We report a case of an 11-year-old boy who developed acute liver failure after neurosurgical intervention, resection of a posterior fossa mass, under sevoflurane anesthesia and other drugs. Postoperatively, he presented abdominal pain and the laboratory tests showed markedly elevated aminotransferase levels, coagulopathy and thrombocytopenia. He had no fever, hypoglycemia or evidence of encephalopathy. The clinical evolution was favorable and after 7 days, laboratory values were completely normalized. All the possible causes of acute liver failure were evaluated and the differential diagnosis is exposed.
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Affiliation(s)
- L Bermúdez Barrezueta
- Servicio de Cuidados Intensivos Pediátricos, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - M Benito Gutiérrez
- Servicio de Cuidados Intensivos Pediátricos, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - B Martínez Rafael
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - R Herraiz Cristóbal
- Servicio de Oncohematología Pediátrica, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - A Pino Vázquez
- Servicio de Cuidados Intensivos Pediátricos, Hospital Clínico Universitario de Valladolid, Valladolid, España
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4
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Bishop B, Hannah N, Doyle A, Amico F, Hockey B, Moore D, Sood S, Gorelik A, Liew D, Njoku D, Nicoll A. A prospective study of the incidence of drug-induced liver injury by the modern volatile anaesthetics sevoflurane and desflurane. Aliment Pharmacol Ther 2019; 49:940-951. [PMID: 30761577 DOI: 10.1111/apt.15168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/18/2019] [Accepted: 01/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Volatile anaesthetics are known to cause drug-induced liver injury, a hepatotoxic reaction characterised by antibodies to trifluoroacetylated lipid and protein adducts and cytochrome p450 2E1. The incidence of volatile anaesthetic drug-induced liver injury from older agents has been described, but modern agents have not been prospectively studied. AIM To determine prospectively the incidence of volatile anaesthetic drug-induced liver injury from sevoflurane and desflurane. METHODS Adult surgical patients with a predicted post-operative stay of at least 4 days were recruited. If volatile anaesthetic was administered, liver biochemistry was performed regularly. Medications, observations and other investigations were documented. Patients with abnormal liver biochemistry were classified as likely volatile anaesthetic drug-induced liver injury or not based on clinical assessment, Roussel Uclaf Causality Assessment Method score, and the absence of other likely pathology. Some patients were also tested for antibodies to both trifluoroacetylated lipid and protein adducts, and cytochrome p450 2E1. RESULTS A total of 209 patients were recruited, of which 121 were included for analysis. Post-operative liver biochemistry was abnormal in 62 patients (51.2%); further classified as not volatile anaesthetic drug-induced liver injury in 47 cases (38.8%), and likely volatile anaesthetic-drug induced liver injury in 15 cases (12.4%). Of the likely volatile anaesthetic drug-induced liver injury patients, only one had severe disease with alanine transaminase greater than five times the upper limit of normal, while four cases had moderate disease with alanine transaminase greater than three times the upper limit of normal. Thus, the incidence of clinically significant volatile anaesthetic drug-induced liver injury was 4.1%. No risk factors were identified. CONCLUSIONS Volatile anaesthetic drug-induced liver injury from modern agents seems to be as common (4.1%) as previously reported with older agents (3%), and may identify patients at risk of severe acute liver injury with subsequent re-exposure.
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Affiliation(s)
- Bridget Bishop
- Melbourne Medical School, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Nicholas Hannah
- Melbourne Medical School, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Adam Doyle
- Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Australia
| | - Francesco Amico
- Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Australia
| | - Brad Hockey
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia
| | - David Moore
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia
| | - Siddharth Sood
- Melbourne Medical School, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Australia
| | - Alexandra Gorelik
- Melbourne Medical School, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Melbourne EpiCentre, Royal Melbourne Hospital, Melbourne, Australia
| | - Danny Liew
- Melbourne Medical School, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Melbourne EpiCentre, Royal Melbourne Hospital, Melbourne, Australia.,Division of Clinical Epidemiology, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Dolores Njoku
- Departments of Anesthesiology and Critical Care Medicine, Pediatrics, and Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Amanda Nicoll
- Melbourne Medical School, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Gastroenterology, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash School of Medicine, Monash University, Melbourne, Australia
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5
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Shi Q, Yang X, Greenhaw JJ, Salminen AT, Russotti GM, Salminen WF. Drug-Induced Liver Injury in Children: Clinical Observations, Animal Models, and Regulatory Status. Int J Toxicol 2017; 36:365-379. [PMID: 28820004 DOI: 10.1177/1091581817721675] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Drug-induced liver injury in children (cDILI) accounts for about 1% of all reported adverse drug reactions throughout all age groups, less than 10% of all clinical DILI cases, and around 20% of all acute liver failure cases in children. The overall DILI susceptibility in children has been assumed to be lower than in adults. Nevertheless, controversial evidence is emerging about children's sensitivity to DILI, with children's relative susceptibility to DILI appearing to be highly drug-specific. The culprit drugs in cDILI are similar but not identical to DILI in adults (aDILI). This is demonstrated by recent findings that a drug frequently associated with aDILI (amoxicillin/clavulanate) was rarely associated with cDILI and that the drug basiliximab caused only cDILI but not aDILI. The fatality in reported cDILI studies ranged from 4% to 31%. According to the US Food and Drug Administration-approved drugs labels, valproic acid, dactinomycin, and ampicillin appear more likely to cause cDILI. In contrast, deferasirox, isoniazid, dantrolene, and levofloxacin appear more likely to cause aDILI. Animal models have been explored to mimic children's increased susceptibility to valproic acid hepatotoxicity or decreased susceptibility to acetaminophen or halothane hepatotoxicity. However, for most drugs, animal models are not readily available, and the underlying mechanisms for the differential reactions to DILI between children and adults remain highly hypothetical. Diagnosis tools for cDILI are not yet available. A critical need exists to fill the knowledge gaps in cDILI. This review article provides an overview of cDILI and specific drugs associated with cDILI.
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Affiliation(s)
- Qiang Shi
- 1 Division of Systems Biology, National Center for Toxicological Research, Food and Drug Administration, Jefferson, AR, USA
| | - Xi Yang
- 1 Division of Systems Biology, National Center for Toxicological Research, Food and Drug Administration, Jefferson, AR, USA
| | - James J Greenhaw
- 1 Division of Systems Biology, National Center for Toxicological Research, Food and Drug Administration, Jefferson, AR, USA
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Turillazzi E, D’Errico S, Neri M, Riezzo I, Fineschi V. A Fatal Case of Fulminant Hepatic Necrosis Following Sevoflurane Anesthesia. Toxicol Pathol 2016; 35:840-5. [PMID: 17943651 DOI: 10.1080/01926230701584148] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Volatile anesthetics can elevate cytosolic free Ca2+ by releasing calcium from internal calcium stores and uptaking calcium from extracellular medium. Sevoflurane is an inhaled anesthetic used worldwide. A clear understanding of the exact mechanism of hepatic injury induced by sevoflurane remains elusive. A 69-year-old man with preexisting mild renal dysfunction, having undergone sevoflurane general anesthesia twice in 2 days, developed moderate jaundice. Liver enzymes strongly increased and remained elevated until death, which occurred on the 6th day after the first surgical intervention. The microscopic liver examination revealed an extensive and confluent hepatic necrosis, characterised by a large amount of calcium deposition in hepatic cell cytoplasm. These data were confirmed by confocal laser scanning microscopy and a 3-D visualization of calcium depositions was evident in hepatocytes cytoplasm. Our findings are suggestive with the previous experimental reports that consider elevation of cytoplasmic calcium may be the basis of sevoflurane – induced hepatotoxicity.
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Affiliation(s)
- Emanuela Turillazzi
- Department of Forensic Pathology, University of Foggia, Ospedali Riuniti, 71100 Foggia, Italy
| | - Stefano D’Errico
- Department of Forensic Pathology, University of Foggia, Ospedali Riuniti, 71100 Foggia, Italy
| | - Margherita Neri
- Department of Forensic Pathology, University of Foggia, Ospedali Riuniti, 71100 Foggia, Italy
| | - Irene Riezzo
- Department of Forensic Pathology, University of Foggia, Ospedali Riuniti, 71100 Foggia, Italy
| | - Vittorio Fineschi
- Department of Forensic Pathology, University of Foggia, Ospedali Riuniti, 71100 Foggia, Italy
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Huang F, Li S, Gan X, Wang R, Chen Z. Propofol inhibits gap junctions by attenuating sevoflurane-induced cytotoxicity against rat liver cells in vitro. Eur J Anaesthesiol 2014; 31:219-24. [PMID: 24145807 DOI: 10.1097/01.eja.0000435059.98170.da] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Liver abnormalities are seen in a small proportion of patients following anaesthesia with sevoflurane. OBJECTIVES To investigate whether the cytotoxicity of sevoflurane against rat liver cells was mediated by gap junction intercellular communications, and the effect of propofol on sevoflurane-induced cytotoxicity. DESIGN Experimental study. SETTING The study was carried out in the central laboratory of The Third Affiliated Hospital, Sun Yat-sen University. CELL LINE BRL-3A rat liver cells. METHODS Immortal rat liver cells BRL-3A were grown at low and high density. Colony-forming assays were performed to determine clonogenic growth of these cells. To investigate the effect of oleamide and propofol on gap junction function, we measured fluorescence transmission between cells using parachute dye-coupling assays. Immunoblotting assays were performed to determine connexin32 and connexin43 expression. RESULTS Our colony formation assays revealed that, in low-density culture, sevoflurane caused no apparent inhibition of clonogenic growth of BRL-3A cells. In high-density culture, 2.2 to 4.4% sevoflurane markedly inhibited clonogenic growth of BRL-3A cells with 67.6 (0.34)% and 61.2 (0.17)% of the cells being viable, respectively (P = 0.003 vs. low-density culture), suggesting cell density dependency of sevoflurane-induced cytotoxicity. Our colony formation assays revealed that propofol markedly attenuated the suppression by sevoflurane of the clonogenic growth of BRL-3A cells (viability: propofol and sevoflurane, 91.5 (0.014)% vs. sevoflurane, 56.6 (0.019)%; P <0.01). Blocking gap junctions with 10 μmol l oleamide significantly attenuated 4.4% sevoflurane-induced suppression with a viability of 83.6 ± 0.138% (oleamide and sevoflurane vs. sevoflurane, P < 0.01). Immunoblotting assays further showed that propofol (3.2 μg ml) markedly reduced CX32 levels and significantly inhibited gap junctional intercellular communications as revealed by parachute dye-coupling assays. Values are mean (SD). CONCLUSION This study provides the first direct evidence that sevoflurane-induced cytotoxicity, which is mediated through gap junctions, is attenuated by propofol, possibly by its action on Cx32 homomeric or heteromeric complexes.
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Affiliation(s)
- Fei Huang
- From the Department of Anaesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
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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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Arslan M, Ozkose Z, Akyol G, Barit G. The age- and gender-dependent effects of desflurane and sevoflurane on rat liver. ACTA ACUST UNITED AC 2009; 62:35-43. [PMID: 19181502 DOI: 10.1016/j.etp.2008.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 12/10/2008] [Accepted: 12/30/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aimed to investigate the age- and gender-dependent effects of desflurane and sevoflurane on the liver. MATERIAL AND METHOD Upon the approval of ethics committee, 84 rats were divided into four groups as 21 young male, 21 young female, 21 old male, and 21 old female rats. Then, each group was further divided into three groups as desflurane, sevoflurane, and control groups. Maintaining the minimum alveolar concentration of 1, desflurane at 6vol% and sevoflurane at 2vol% in 6Lmin(-1) 100% O2 were administered for 2h in a transparent plastic container of 40cmx40cmx70cm. Each liver preparation was evaluated for hydropic degeneration, nuclear polymorphism, portal neutrophile infiltration, portal lymphocyte infiltration, and focal necrosis, and each preparation was assigned injury points of 0-3; thus, the number of histopathologically injured cases, total injury scores of each preparation, and the mean injury scores of each group were determined. RESULTS Desflurane and sevoflurane did not significantly increase hepatic injury in the young male rats, while both agents caused significantly more hepatic injury in the young female rats. In the old rats, both desflurane and sevoflurane inflicted more hepatic injury on both genders. In addition, desflurane caused more hepatic injury in the old female rats than in the young female or the old male rats. CONCLUSION Hepatic injury associated with desflurane and sevoflurane was mild to moderate, suggesting that both agents can be safely used in routine anaesthesia procedures.
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Affiliation(s)
- M Arslan
- Department of Anaesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey.
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11
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Fernández-Meré LA, Muñoz González F, Sopena Zubiria LA, Alvarez Blanco M. [Sevoflurane and liver dysfunction]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2008; 55:184-185. [PMID: 18401994 DOI: 10.1016/s0034-9356(08)70538-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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12
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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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