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Severe desflurane hepatotoxicity after colon surgery in an elderly patient

[Sévère hépatotoxicité au desflurane après une opération du colon chez une patiente âgée]

Dean Tung, BSc^*, Eric M. Yoshida, MD FRCPC(C)^,, Charlie S. K. Wang, MD and Urs P. Steinbrecher, MD FRCPC(C)^,

^* From the Undergraduate School of Medicine,
the Department of Medicine, and
the Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.

Address correspondence to: Dr. Eric M. Yoshida, Vancouver General Hospital, Division of Gastroenterology, 100-2647 Willow Street, Vancouver, B.C. V5Z 3P1, Canada. Phone: 604-875-5371; Fax: 604-875-5447; E-mail: eyoshida{at}interchange.ubc.ca

Purpose: To report a case of desflurane hepatotoxicity.

Clinical features: An 81-yr-old woman with a remote history of abdominal surgery developed severe acute liver injury after general anesthesia with desflurane for resection of colonic cancer. Serum alanine aminotransferase and aspartate aminotransferase peaked at postoperative day six (2188 and 425 U•L^–1 respectively), with the development of coagulopathy with an international normalized ratio of 2.29 on postoperative day eight, progressive jaundice with a peak serum total bilirubin of 214 µmol•L^–1 on postoperative day 12 and hepatic encephalopathy on postoperative day ten. Other causes for liver disease were excluded. Treatment with corticosteroids was started. The liver biochemistry normalized completely by postoperative day 30 and the patient was discharged from hospital on postoperative day 21.

Conclusions: To our knowledge, this represents only the third report of desflurane hepatotoxicity and the first with reversible fulminant liver failure. Our experience suggests that all fluorinated anesthetics may cause acute hepatic damage.

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