Biermann J S, Rice S A, Fish K J, Serra M T
Department of Anesthesia, Stanford University School of Medicine, California.
Anesthesiology. 1989 Sep;71(3):431-7. doi: 10.1097/00000542-198909000-00020.
Halothane is metabolized by an oxidative pathway to stable, nonvolatile end products, trifluoroacetic acid (TFAA) and bromide (Br-), and by reductive pathways to Br-and inorganic fluoride (F-). There is evidence that both oxidatively and reductively formed intermediates may produce hepatotoxicity, although the exact etiology of the fulminant hepatic necrosis seen in humans is unproven. Obese patients receiving volatile anesthetics exhibit higher serum anesthetic metabolite concentrations than do normal-weight patients, and thus might be at greater risk of hepatotoxicity because of higher concentrations of reactive intermediates from halothane metabolism. To eliminate the variables inherent in human clinical studies leading to confounding interpretation of data, this study determined the contributions of oxidative and reductive pathways to halothane metabolism in an animal model of human hypertrophic obesity, the most common form of human obesity. Eight pairs of obese (high-fat diet) and normal-weight (standard chow), male Fischer 344 rats were anesthetized with halothane for 4 h at an inspired concentration of 0.78%. Serum and urinary concentrations of TFAA, Br-, and F-were measured. Thirty-six hours following halothane anesthesia, mean serum TFAA concentrations peaked at 7.3 +/- 1.1 mM in obese rats and 4.7 +/- 0.7 mM in nonobese rats. TFAA urinary excretions during the 180-h period postanesthesia were 519 +/- 69 and 336 +/- 22 mumol, respectively. Peak serum Br- concentrations were 9.1 +/- 1.0 and 6.9 +/- 0.6 mM for obese and nonobese rats, respectively, and Br-urinary excretions were 127 +/- 30 and 79 +/- 14 mumol, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
氟烷通过氧化途径代谢为稳定的、非挥发性终产物三氟乙酸(TFAA)和溴化物(Br-),并通过还原途径代谢为Br-和无机氟化物(F-)。有证据表明,氧化和还原形成的中间体均可能产生肝毒性,尽管人类中暴发性肝坏死的确切病因尚未得到证实。接受挥发性麻醉剂的肥胖患者血清麻醉剂代谢物浓度高于正常体重患者,因此由于氟烷代谢产生的反应性中间体浓度较高,可能面临更高的肝毒性风险。为消除人类临床研究中导致数据解释混淆的固有变量,本研究在人类肥厚性肥胖(人类肥胖最常见的形式)动物模型中确定了氧化和还原途径对氟烷代谢的贡献。八对肥胖(高脂饮食)和正常体重(标准饲料)的雄性Fischer 344大鼠,以0.78%的吸入浓度用氟烷麻醉4小时。测量血清和尿液中TFAA、Br-和F-的浓度。氟烷麻醉36小时后,肥胖大鼠血清TFAA平均浓度在7.3±1.1 mM达到峰值,非肥胖大鼠为4.7±0.7 mM。麻醉后180小时内TFAA尿排泄量分别为519±69和336±22 μmol。肥胖和非肥胖大鼠血清Br-峰值浓度分别为9.1±1.0和6.9±0.6 mM,Br-尿排泄量分别为127±30和79±14 μmol。(摘要截短于250字)