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Canadian Journal of Anesthesia, Vol 10, 531-538, Copyright © 1963 by Canadian Anesthesiologists' Society

Postanaesthetic Liver Complications in a General Hospital: A Statistical Study

MICHAEL KEÉRI-SZÁNTÓ M.D.1 and FRANCOIS LAFLEUR M.D.1

1 Anaesthesia Department of Notre Dame Hospital, Montreal

1. We have studied the hospital records of patients who were anaesthetized while suffering from certain liver conditions or who developed such conditions following the exhibition of an anaesthetic. One hundred and five such cases turned up in four years in a 1000-bed teaching hospital.

2. Eleven postanaesthetic complications (seven of these fatal) were diagnosed in patients with no known pre-anaesthetic liver disease. Six fatalities followed halothane-nitrous oxide anaesthesia, the seventh patient received a spinal. This distribution does not differ significantly from the ratio of halothane to other anaesthetics employed in our hospital.

3. Sixteen postanaesthetic complications (eleven fatal, seven of these classified as hepatic deaths) were encountered among the 94 cases with known hepatic disease. In this group halothane anaesthesia was associated with proportionately fewer complications than other anaesthetics.

4. Calculations and considerations are presented to show that blood transfusions or concurrent virus hepatitis are not likely to account for the observed complications. On the other hand, interference with the hepatic blood flow either by the surgeon or by the anaesthesia cannot be excluded from the aetiology.

5. We conclude that: (a) Serious post-anaesthetic hepatic complications will occur rarely but regularly, affecting particularly postmenopausal women undergoing abdominal surgery; (b) some doubt must exist about the role of halothane in the production of such complications; (c) pre-existing liver disease increases the chances of hepatic complications more than five-hundred-fold but does not appear to sensitize the bearer against halothane; (d) special risk cases should receive halothane on theoretical grounds not in nitrous oxide but in 100 per cent oxygen.

Note:

Read in part at the Annual Meeting of the Canadian Anaesthetists' Society at Montebello, Quebec, May 1963. The authors wish to express their gratitude to Dr. S. Lauzé of the Hospital's Pathology Department and to Mlle M. Lavergne of the Medical Records Library for their valuable assistance in this study.






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Copyright © 1963 by the Canadian Anesthesiologists' Society.