Lee Moon Ok, Cho Seonghyeon, Kim Chaeeun, Koh Hanna
Department of Anesthesia and Pain Medicine, Samsung Changwon Hospital, Changwon, Korea.
Anesth Pain Med (Seoul). 2024 Jul;19(3):227-232. doi: 10.17085/apm.24027. Epub 2024 Jul 31.
Several factors contribute to post-anesthetic hepatic dysfunction, including a decrease in oxygen supply to the liver, direct physical compression of the liver, viral hepatitis, blood transfusions, preexisting hepatic dysfunction, and the use of hepatotoxic drugs. Diagnosing volatile anesthetic drug-induced liver injury (VA-DILI) involves excluding these causes.
The patient underwent total mastectomy under anesthesia using sevoflurane. He had diabetes, and no abnormal results were found on preoperative laboratory examinations, and surgery was uneventful. Abnormal laboratory findings were observed after surgery, including an aspartate aminotransferase level of 1,417 IU/L, an alanine aminotransferase level of 2,176 IU/L, and a total bilirubin level of 3.8 mg/dl. He presented with symptoms of mild icteric sclera, fatigue, and pruritus. After ruling out other causes of liver injury, we concluded that these results indicated VA-DILI.
VA-DILI, though rare, we should be aware of the association between the disease and the use of halogenated anesthetics.
多种因素可导致麻醉后肝功能障碍，包括肝脏氧供减少、肝脏直接受到物理压迫、病毒性肝炎、输血、术前已存在的肝功能障碍以及使用肝毒性药物。诊断挥发性麻醉药物所致肝损伤（VA-DILI）需要排除这些病因。
该患者在使用七氟醚麻醉下接受了全乳切除术。他患有糖尿病，术前实验室检查未发现异常结果，手术过程顺利。术后观察到实验室检查结果异常，包括天冬氨酸转氨酶水平为1417 IU/L、丙氨酸转氨酶水平为2176 IU/L以及总胆红素水平为3.8 mg/dl。他出现了轻度巩膜黄染、疲劳和瘙痒症状。在排除其他肝损伤病因后，我们得出结论，这些结果提示为VA-DILI。
VA-DILI虽然罕见，但我们应意识到该疾病与卤代麻醉剂使用之间的关联。
