FLUORIDE 30 (1)  1997, p. 70	International Society for Fluoride Research	Table of Contents

INHALATION ANAESTHETICS AND LIVER DAMAGE

R S Henderson, Wellington, New Zealand
Abstracted from Prescriber Update 13 6-7 1996

Halothane anaesthesia may cause liver damage which can be fatal. Halothane is contraindicated within at least 3 months of a previous administration, where jaundice or pyrexia followed any previous use, and in those with a family history of hepatic reactions following halothane. Other volatile anaesthetic agents are best avoided in the presence of risk factors for halothane-induced hepatitis.

Recently the Medicines Adverse Reactions Committee reviewed two cases of hepatic reactions following halothane anaesthesia. Both patients had received halothane (trade name Fluothane) previously. For one patient the timing of the previous dose was unclear, for the other the previous dose was administered 9 days previously. The former patient (53-year-old woman) developed hepatic and renal failure requiring haemodialysis for one month while the latter patient (60-year-old man) developed fulminant hepatic failure and died.

Up to December 1995, the Centre for Adverse Reactions Monitoring (CARM) had received 74 reports of hepatic reactions associated with halothane, of which 50 were severe. Ten fatalities were probably or possibly causally associated with the use of halothane.

Halothane hepatitis appears to be associated with metabolites of halothane, but several factors suggest that the mechanism is not a direct hepatotoxicity. Firstly, the interval from anaesthesia to onset of jaundice is typically around 7 days. Secondly, the development of hepatitis is often associated with pyrexia, rash, arthralgia and immune sensitisation. Thirdly, in at least 80% of the cases reviewed, halothane had been administered previously.

Other more recently available inhalation anaesthetics, enflurane, isoflurane, desflurane and sevoflurane are metabolised to a lesser degree than halothane. Nevertheless, enflurane and isoflurane are associated with hepatic dysfunction, albeit apparently at lower rates than halothane. There is limited clinical experience with desflurane and sevoflurane. CARM has 4 reports of hepatic reaction associated with isoflurane (1 patient had also received halothane) and 1 with enflurane, and the WHO database holds 225 and 159 reports, respectively.

Key words: Anaesthetics; Halothane; Hepatitis; Liver.
Reprints: Ministry of Health, PO Box 5013, Wellington, New Zealand.

FLUORIDE 30 (1)  1997, p. 70	International Society for Fluoride Research
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