Advances in evaluating liver response to operating theatre work: urinary D-glucaric acid as an index of effect

The contribution of operating theatre work to specific diseases is still a controversial matter involving a variety of risk factors. The concept that the liver plays a central role in anaesthetics biotransformation stimulated numerous studies aimed at establishing the occurrence of liver changes and at verifying the relationship between liver disease and anaesthetics. The liver microsomal enzyme system has received particular attention in order to clarify the mechanism involved in anaesthetics hepatotoxicity and an increased microsomal activity has been detected in experimental conditions and in humans. In particular, a significant increase in the excretion of urinary D-glucaric acid (UDGA) in subjects occupationally exposed to anaesthetic mixture was observed. Nevertheless, few results exist about the relationship between UDGA increase and environmental anaesthetic concentration, and mechanisms responsible for UDGA increase still need to be clarified. Attention is focused, however, on the possibility of using UDGA as an index reflecting an adaptation effect (rather than an injury effect), which may represent a more adequate approach for evaluating any change related to working in the operating theatre.