Fatal hepatic necrosis after high-dose chemotherapy following haloalkane anesthesia

We describe two patients who died with rapidly progressive hepatic necrosis following intensive chemotherapy and haloalkane anesthesia. Intensive multiple-drug chemotherapy has been associated with severe systemic toxic effects, but fulminant hepatic necrosis has not been recognized as a frequent complication. Furthermore, overt hepatic injury following the currently used halogenated anesthetic agents alone is rare without prior exposure and generally is considered to be idiosyncratic, ie, dependent upon unusual patient vulnerability. The unanticipated hepatic failure in these patients is reported to alert clinicians to this potential complication of intensive cancer chemotherapy and the possible additive adverse effect of haloalkane anesthesia.