Current concept of halothane hepatitis (review)

Clinically, halothane is still a useful volatile anesthetic, but since many cases of liver disorders considered attributable to halothane have been reported up to date, a number of studies have been made on the etiology and mechanism of halothane hepatitis. There are at least two possible mechanisms of halothane hepatitis; the first is the direct toxic reaction associated with free radical that is related to reductive pathway enhanced by hypoxia, and the other is the immune--mediated reaction in which the antigen is associated with the oxidative and/or reductive route. However, the etiology and mechanism of halothane hepatitis have yet to be elucidated, and clinically there is no obvious evidence that halothane can induce hepatic disorders. We have concluded at present that the use of halothane should be avoided in patients with liver disorders, in patients under long-term administration of drugs that may induce enzymes involved in halothane metabolism, in patients with high allergic sensitivity, and in patients undergoing operations in which liver circulation is reduced.