Kreienbühl G
Anaesthesist. 1981 Jan;30(1):1-10.
"Hepatitis" following halothane-anesthesia is a rare complication, occurring once after about 2500 halothane-anaesthesias. The mortality is estimated to be 20-25%. The disease can be diagnosed by exclusion of other causes only. The differential diagnosis of postoperative jaundice is therefore briefly reviewed. Three hypotheses of possible pathogenic mechanisms are discussed, namely the theory of toxic products of the metabolism of halothane, the theory of delayed hypersensitivity to a metabolite and the theory of coincidence with preexisting unknown liver disease. None of these theories has been proved definitely. The use of halothane is contraindicated if a patient suffered from unexplained pyrexia and jaundice after a previous exposure to halothane. Gamma radiation decomposes halothane to hexachlorofluorobutene, a know hepatotoxin. The repeated use of halothane during irradiation therapy is therefore contraindicated. The risk of "hepatitis" after halothane anaesthesia increases if the patient is exposed to halothane twice within four weeks, especially if he is obese and older than 40 years. The risks and advantages of repeated halothane exposures have to be weighed against the risks of alternative techniques. The increased mortality after repeated anaesthesias within short periods of time, irrespective of the technique used, has to be considered.
氟烷麻醉后出现的“肝炎”是一种罕见的并发症，大约每2500例氟烷麻醉中会出现1例。据估计，其死亡率为20% - 25%。该疾病只能通过排除其他病因来诊断。因此，本文简要回顾了术后黄疸的鉴别诊断。讨论了三种可能的致病机制假说，即氟烷代谢产物的毒性理论、对代谢产物的迟发型超敏反应理论以及与先前未知的肝脏疾病巧合的理论。这些理论均未得到确切证实。如果患者在先前接触氟烷后出现不明原因的发热和黄疸，则禁忌使用氟烷。伽马射线可将氟烷分解为六氯氟丁烯，这是一种已知的肝毒素。因此，在放射治疗期间禁忌重复使用氟烷。如果患者在四周内两次接触氟烷，尤其是肥胖且年龄超过40岁的患者，氟烷麻醉后发生“肝炎”的风险会增加。必须权衡重复接触氟烷的风险和益处与其他技术的风险。无论使用何种技术，短期内重复麻醉后死亡率增加的情况都必须予以考虑。
