Chung Peter Chi-Ho, Chiou Shyh-Ching, Lien Jau-Min, Li Allen H, Wong Chung-Hang
Department of Anesthesiology, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC.
Chang Gung Med J. 2003 May;26(5):357-62.
Both desflurane and sevoflurane have individually been reported to induce hepatic dysfunction; however hepatic dysfunction after administration of both of them separately in a single patient has not previously been reported. As their metabolites differ in nature, we considered that it would be unlikely that their combined use would cause sensitization and induce hepatic dysfunction. We report on the first patient with reproducible liver dysfunction after sevoflurane and desflurane. This 54-year-old man sequentially received 3 anesthetics over a 1-year period. The first anesthetic was isoflurane, and the course was uneventful. The second anesthetic was sevoflurane, and this resulted in fever with chills and elevated aspartate aminotransferase (543 U/l) 17 days later. The third anesthetic was desflurane which resulted in a similar clinical picture after 17 days. The symptoms improved, and the serum transaminase level returned to normal after conservative therapy. The similar time interval between the operation date and the onset of hepatic dysfunction, after excluding other possibilities, made us highly suspicious that the hepatic dysfunction was induced by sevoflurane on 1 occasion and desflurane on the other. We suggest that inhaled anesthetics should be totally replaced by intravenous anesthetics for future operations in patients with such a diagnosis.
曾有报告分别指出地氟烷和七氟烷均可诱发肝功能障碍；然而，此前尚无在同一患者身上分别使用这两种药物后发生肝功能障碍的报道。由于它们的代谢产物性质不同，我们认为两者联合使用不太可能导致致敏并诱发肝功能障碍。我们报告了首例在使用七氟烷和地氟烷后出现可复发性肝功能障碍的患者。该54岁男性在1年时间内先后接受了3次麻醉。第一次麻醉使用异氟烷，过程顺利。第二次麻醉使用七氟烷，17天后出现发热伴寒战，天冬氨酸转氨酶升高（543 U/l）。第三次麻醉使用地氟烷，17天后出现类似临床表现。经保守治疗后症状改善，血清转氨酶水平恢复正常。排除其他可能性后，手术日期与肝功能障碍发作之间相似的时间间隔，使我们高度怀疑肝功能障碍一次是由七氟烷诱发，另一次是由地氟烷诱发。我们建议，对于有此类诊断的患者，未来手术应完全用静脉麻醉剂替代吸入麻醉剂。
