Retrospective study of post-anesthetic mild liver disorder associated with inhalation anesthetics, halothane and enflurane

A prospective study of the incidence of drug-induced liver injury by the modern volatile anaesthetics sevoflurane and desflurane

BACKGROUND

Volatile anaesthetics are known to cause drug-induced liver injury, a hepatotoxic reaction characterised by antibodies to trifluoroacetylated lipid and protein adducts and cytochrome p450 2E1. The incidence of volatile anaesthetic drug-induced liver injury from older agents has been described, but modern agents have not been prospectively studied.

AIM

To determine prospectively the incidence of volatile anaesthetic drug-induced liver injury from sevoflurane and desflurane.

METHODS

Adult surgical patients with a predicted post-operative stay of at least 4 days were recruited. If volatile anaesthetic was administered, liver biochemistry was performed regularly. Medications, observations and other investigations were documented. Patients with abnormal liver biochemistry were classified as likely volatile anaesthetic drug-induced liver injury or not based on clinical assessment, Roussel Uclaf Causality Assessment Method score, and the absence of other likely pathology. Some patients were also tested for antibodies to both trifluoroacetylated lipid and protein adducts, and cytochrome p450 2E1.

RESULTS

A total of 209 patients were recruited, of which 121 were included for analysis. Post-operative liver biochemistry was abnormal in 62 patients (51.2%); further classified as not volatile anaesthetic drug-induced liver injury in 47 cases (38.8%), and likely volatile anaesthetic-drug induced liver injury in 15 cases (12.4%). Of the likely volatile anaesthetic drug-induced liver injury patients, only one had severe disease with alanine transaminase greater than five times the upper limit of normal, while four cases had moderate disease with alanine transaminase greater than three times the upper limit of normal. Thus, the incidence of clinically significant volatile anaesthetic drug-induced liver injury was 4.1%. No risk factors were identified.

CONCLUSIONS

Volatile anaesthetic drug-induced liver injury from modern agents seems to be as common (4.1%) as previously reported with older agents (3%), and may identify patients at risk of severe acute liver injury with subsequent re-exposure.

Drug-induced hepatotoxicity: incidence of abnormal liver function tests consistent with volatile anaesthetic hepatitis in trauma patients

BACKGROUND & AIMS

Volatile anaesthetic drug-induced liver injury can range from asymptomatic alanine transaminase elevations to fatal hepatic necrosis. There is very limited research regarding hepatotoxicity of modern volatile anaesthetic agents. The aim of this study was to determine how common liver injury consistent with volatile anaesthetic hepatitis is, following exposure to isoflurane, desflurane and sevoflurane; and to propose risk factors for its development.

METHODS

Following ethics approval, we conducted a retrospective audit of adult trauma patients with abnormal liver biochemistry following volatile anaesthesia during January 1 to December 31, 2009. The data collected included patient demographics, volatile anaesthetic administration, concurrent medication, perioperative liver biochemistry results and comorbidities. The Council for International Organisations of Medical Sciences/Roussel Uclaf Causality Assessment Method scoring system was used to group cases according to the likelihood of volatile anaesthetic being the causative agent of drug-induced hepatotoxicity.

RESULTS

Forty-seven (3%) of 1556 patients had abnormal post-operative liver biochemistry potentially attributable to volatile anaesthetic. Of the 47, 12 patients (26%) had peak alanine transaminase levels greater than 200 U/L. No significant predictors of volatile anaesthetic drug-induced liver injury following isoflurane, desflurane or sevoflurane anaesthesia could be identified.

CONCLUSION

Volatile anaesthetic drug-induced liver injury in adult trauma patients may be significantly more common than previously noted. This study suggests that about a quarter of patients with volatile anaesthetic drug-induced liver injury develop significant liver injury. Further prospective studies are required to define risk factors and clinical outcomes.

Longitudinal characteristic curve of liver disease

A longitudinal characteristic curve of chronic liver disease (LCC-LD) is derived for the first time by a new method of time series data analysis, where a hospital information system is utilized as a clinical research application of the database. It describes a typical pattern of development of disease from the beginning of chronic hepatitis to the final stage of cirrhosis. The LCC-LD is obtained by effectively using patient data with various stages of developments of liver disease and the present method is applicable to derive the LCC of other diseases. The obtained LCC-LD may be useful for a clinical decision making support such as the prospective assessment (for example, the onset time of cirrhosis) of liver disease in individual patients, an evaluation of drug effect, etc.