[A case of postoperative hepatic injury after sevoflurane anesthesia]

Area of Science:

• Anesthesiology
• Hepatology
• Immunology

Background:

• A 63-year-old man underwent two surgical procedures involving halogenated inhalation anesthetics within a short period.
• The first surgery was for middle cerebral artery (MCA) aneurysmal neck clipping under O2-N2O-enflurane anesthesia.
• The second surgery, cranioplasty, was performed 46 days later under O2-N2O-sevoflurane anesthesia.

Observation:

• Postoperatively, the patient developed significant hepatic injury, indicated by elevated liver enzymes (GOT, GPT) and bilirubin levels.
• Clinical signs of hepatic encephalopathy, hyperammonemia, and disseminated intravascular coagulation (DIC) were notably absent.
• The patient's liver function improved with conservative management.

Findings:

• Hepatitis viruses and drug-induced hepatotoxicity were ruled out as causes of liver injury.
• Drug-induced lymphocyte stimulating test (DLST) results suggested cross-sensitization between enflurane and sevoflurane as the likely cause of hepatic injury.
• The study highlights a potential link between repeated exposure to specific halogenated inhalation anesthetics and liver damage.

Implications:

• Anesthetic management requires careful consideration of potential hepatotoxicity, especially in patients undergoing repeated anesthesia and surgeries.
• Cross-sensitization between halogenated anesthetics like enflurane and sevoflurane is a critical factor to consider in preventing adverse hepatic events.
• Further research into the immunological mechanisms of anesthetic-induced liver injury is warranted.