Fulminant hepatic failure after repeated exposure to isoflurane

Area of Science:

• Anesthesiology
• Hepatology
• Pediatric Critical Care

Background:

• Inhalational anesthetics are common for anesthesia maintenance.
• Halothane is known to cause post-anesthesia hepatic failure.
• Isoflurane-induced liver injury is rarely reported.

Purpose of the Study:

• To report a case of fulminant hepatic failure in a child following isoflurane anesthesia.
• To investigate potential causes of hepatitis in the absence of other etiological factors.

Main Methods:

• A 6-year-old child underwent craniotomy under general anesthesia.
• Post-operative liver function was monitored.
• Differential diagnoses for hepatitis were excluded.
• Histological examination of liver tissue was performed.

Main Results:

• The child developed fulminant hepatic failure 2 days post-operatively.
• Viral, autoimmune, and metabolic causes of hepatitis were ruled out.
• No hepatotoxic medications were administered, except low-dose paracetamol.
• Clinical and histological findings resembled halothane hepatitis.

Conclusions:

• Isoflurane exposure may be a potential cause of fulminant hepatic failure.
• This complication, though rare, carries a significant mortality risk.
• Pediatric patients may be susceptible to isoflurane-induced hepatotoxicity.