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Desfluran anestezisi sonrası karaciğer toksisitesi: olgu sunumu ve gözden geçirme

Yıl 2012, Cilt: 22 Sayı: 4, 130 - 134, 01.01.2012

Öz

Geleneksel inhalasyon anestezik ajanların ılımlı ve bazen de şiddetli karaciğer yetmezliğine yol açtıkları müşahade edilmiştir. Ancak yeni inhalasyon ajanları primer hepatotoksisitenin nedeni olarak kabul edilemezler. Bu olgu sunumunda laparoskopik kolesistektomi planlanan hipertansiyonu, peptik ülseri ve hiperlipidemisi olan ASA II, 65 yaşında kadın hastada desflurana bağlı karaciğer yetmez- liğini tanımladık. Preoperatif laboratuar değerleri normaldi. Operasyon esnasında, midazolam, remifentanil, sodyum tiyopental ve vekuronyum devamında da desfluran anestezisi uygulandı. Peroperatif 4L CO2 ile CO2 insuflasyon basıncı 15 mmHg’da tutuldu. Per operatif hastanın hemodinamik parametreleri stabil olarak dökümante edildi. Laparoskopik kolesistektomi operasyonu 135 dakika sürdü. Serum alanin aminotransferaz ve aspartat aminotransferaz düzeyi postoperatif 2. günde sırasıyla 711 ve 621 U/L idi. Karaciğer enzimleri postoperatif 13. günde normale döndü ve hasta 15. günde taburcu edildi. Biz hepatotoksisiteyi bir önceki anestezi uygu- lanması sonrası, operasyonda uygulanan desfluran ile ilişkilendiriyoruz. Gelecekte hasta anestezi alacaksa total intravenöz anestezi uygulanabilir

Kaynakça

  • Wright R, Eade OE, Chisholm M, et al. Controlled prospective study of the effect on liver function of multiple exposure to halot- hane. Lancet 1975;1:817–20.
  • Moult PJ, Sherlock S. Halothane-related hepatitis:A clinical study of 26 cases. Q J Med 1975;44:99–114.
  • Miller RD. Metabolism and toxicity of ınhaled anesthetics. In:Mil- ler RD. Miller’s Anesthesia. 5rd ed Elsevier Churchill Livingstone. 2000, pp .147–73.
  • Palmer SN, Giesecke NM, Body SC, Shernan SK, Fox AA, Collard CD. Pharmacogenetics of anesthetic and analgesic agents. Anest- hesiology 2005;102:663–71.
  • Njoki DB, Shrestha S, Soloway R, et al. Subcellular localization of trifluoroacetylated liver proteins in association with hepatitis fol- lowing isoflurane. Anesthesiology 2002;96:757–61.
  • Christ DD, Satoh H, Kenna JG, Pohl LR. Potential metabolic basis for enflurane hepatitis and the apparent cross-sensitization betwe- en enflurane and halothane. Drug Metab Dispos 1988;16:135–40.
  • Koblin DD. Characteristics and implications of desflurane metabo- lism and toxicity. Anesth Analg 1992;75:10–6.
  • Martin JL, Plevak DJ, Flannery KD, et al. Hepatotoxicity after desf- lurane anesthesia. Anesthesiology 1995;83:1125–9.
  • Berghaus TM, Baron A, Geier A, Lamerz R, Paumgartner G. Hepatotoxicity following desflurane anesthesia. Hepatology 1999;29:613–4.
  • Chung PC, Chiou SC, Lien JM, Li AH, Wong CH. Reproducible hepatic dysfunction following separate anesthesia with sevoflurane and desflurane. Chang Gung Med J 2003;26:357–62.
  • Tung D, Yoshida EM, Wang CS, Steinbrecher UP. Severe desflurane hepatotoxicity after colon surgery in an elderly patient. Can J Ana- esth 2005;52:133–6.
  • Cote G, Bouchard S. Hepatotoxicity after desflurane anesthesia in a 15-month-old child with Mobius syndrome after previous exposu- re to isoflurane. Anesthesiology 2007;107:843-5.
  • Chin WM, Njoku DB, Mac Quillan G, Cheng WS, Kontorinis N. Desflurane-induced acute liver failure. Med J Aust 2008;189:293-4.
  • Barash PG, Cullen BF, Stoelting RK. Anestezi ve karaciğer. Klinik Anestezi El Kitabı. 3. Baskı. İzmir, Logos Yayıncılık 1999, s 390- 6.
  • İliçin G, Biberoğlu K, Süleymanlar G, Ünal S. Toksik ve ilaca bağlı hepatitler. İç Hastalıkları Cilt I. Ankara, Güneş Kitabevi, 2003, s 1711-30.
  • Eger E1 2nd. New inhaled anaesthetics. Anesthesiology 1994;80:906–22.
  • Suttner SW, Schmidt CC, Boldt J, Ingo H Bernhard K, Swen PN. Low-flow desflurane and sevoflurane anesthesia minimally affect hepatic integrity and function in elderly patients. Anesth Analg 2000;91:206–12.
  • Arslan M, Özköse Z, Akyol G, Barıt G. The age and gender depen- dent effects of desflurane and sevoflurane on rat liver. Exp Toxicol Pathol 2010;62:35-43.
  • Arslan M, Işık B, Ünal Y, Nurlu N, Özköse Z, Çomu FM, et al. Ef- fects of sevoflurane and desflurane on oxidant/antioxidant status of young versus old rat liver tissues. J Anim Vet Adv 2008;7:1345-51.
  • Morgan GE, Mikhail MS, Murray MJ. Hepatic physiology and anesthesia In: Clinical Anesthesiology. 3rd ed. McGraw-Hill Com- panies. 2002, pp;708–22.
  • Richter S, Olinger A, Hildebrandt U, Menger MD, Vollmar B. Loss of physiologic hepatic blood flow control (“hepatic arterial buffer response”) during CO2- pneumoperitoneum in the rat. Anesth Analg 2001;93:872-7.
  • Sato K, Kawamura T, Wakusawa R. Hepatic blood flow and func- tion in elderly patients undergoing laparoscopic cholecystectomy. Anesth Analg 2000;90:1198-202.
  • Tan M, Xu FF, Peng JS, Li DM, Chen LH, Lv BJ, et al. Changes in the level of serum liver enzymes after laparoscopic surgery. World J Gastroenterol 2003;9:364-7.
  • Patel SS and Goa KL. Desflurane:A review of its pharmacodynamic and pharmacokinetic properties and its efficacy in general anaest- hesia. Drugs 1995;50:742–67.

Hepatotoxicity following desflurane anesthesia: a case report and review

Yıl 2012, Cilt: 22 Sayı: 4, 130 - 134, 01.01.2012

Öz

It has been well established that traditional inhalational anaesthetic agents can cause mild and sometimes fulminant liver failure. However, while newer inhalational agents are a theoretical cause of hepatotoxicity. We describe desflurane-induced acute liver failure in a 65-year-old woman with hypertension, peptic ulcus, and hyperlipidaemia. The patient ASAII was scheduled for laparoscopic cholecystectomy. Her preoperative laboratory findings were normal. In the laparoscopic cholecystectomy operation anesthesia was induced with midazolam, remifentanil, sodium thiopental and vecuronium and maintained with desflurane anesthesia. The CO2 insuflation pressure was kept at 15 mmHg with peroperative 4L CO2 . Perioperatively the patient was stable with documented hemodynamic parameters, laparoscopic cholecystectomy operation was 135 minutes. Serum alanine aminotransferase and aspartate aminotransferase peaked at postoperative day two 711 and 621 U/L, respectively . The liver biochemistry normalized completely by postoperative day 13 and the patient was discharged from hospital on postoperative day 15. We believe this to be a case of hepatotoxicity related to desflurane exposure after previous exposure to anesthesia. In the future, this patient will receive total intravenous anesthesia

Kaynakça

  • Wright R, Eade OE, Chisholm M, et al. Controlled prospective study of the effect on liver function of multiple exposure to halot- hane. Lancet 1975;1:817–20.
  • Moult PJ, Sherlock S. Halothane-related hepatitis:A clinical study of 26 cases. Q J Med 1975;44:99–114.
  • Miller RD. Metabolism and toxicity of ınhaled anesthetics. In:Mil- ler RD. Miller’s Anesthesia. 5rd ed Elsevier Churchill Livingstone. 2000, pp .147–73.
  • Palmer SN, Giesecke NM, Body SC, Shernan SK, Fox AA, Collard CD. Pharmacogenetics of anesthetic and analgesic agents. Anest- hesiology 2005;102:663–71.
  • Njoki DB, Shrestha S, Soloway R, et al. Subcellular localization of trifluoroacetylated liver proteins in association with hepatitis fol- lowing isoflurane. Anesthesiology 2002;96:757–61.
  • Christ DD, Satoh H, Kenna JG, Pohl LR. Potential metabolic basis for enflurane hepatitis and the apparent cross-sensitization betwe- en enflurane and halothane. Drug Metab Dispos 1988;16:135–40.
  • Koblin DD. Characteristics and implications of desflurane metabo- lism and toxicity. Anesth Analg 1992;75:10–6.
  • Martin JL, Plevak DJ, Flannery KD, et al. Hepatotoxicity after desf- lurane anesthesia. Anesthesiology 1995;83:1125–9.
  • Berghaus TM, Baron A, Geier A, Lamerz R, Paumgartner G. Hepatotoxicity following desflurane anesthesia. Hepatology 1999;29:613–4.
  • Chung PC, Chiou SC, Lien JM, Li AH, Wong CH. Reproducible hepatic dysfunction following separate anesthesia with sevoflurane and desflurane. Chang Gung Med J 2003;26:357–62.
  • Tung D, Yoshida EM, Wang CS, Steinbrecher UP. Severe desflurane hepatotoxicity after colon surgery in an elderly patient. Can J Ana- esth 2005;52:133–6.
  • Cote G, Bouchard S. Hepatotoxicity after desflurane anesthesia in a 15-month-old child with Mobius syndrome after previous exposu- re to isoflurane. Anesthesiology 2007;107:843-5.
  • Chin WM, Njoku DB, Mac Quillan G, Cheng WS, Kontorinis N. Desflurane-induced acute liver failure. Med J Aust 2008;189:293-4.
  • Barash PG, Cullen BF, Stoelting RK. Anestezi ve karaciğer. Klinik Anestezi El Kitabı. 3. Baskı. İzmir, Logos Yayıncılık 1999, s 390- 6.
  • İliçin G, Biberoğlu K, Süleymanlar G, Ünal S. Toksik ve ilaca bağlı hepatitler. İç Hastalıkları Cilt I. Ankara, Güneş Kitabevi, 2003, s 1711-30.
  • Eger E1 2nd. New inhaled anaesthetics. Anesthesiology 1994;80:906–22.
  • Suttner SW, Schmidt CC, Boldt J, Ingo H Bernhard K, Swen PN. Low-flow desflurane and sevoflurane anesthesia minimally affect hepatic integrity and function in elderly patients. Anesth Analg 2000;91:206–12.
  • Arslan M, Özköse Z, Akyol G, Barıt G. The age and gender depen- dent effects of desflurane and sevoflurane on rat liver. Exp Toxicol Pathol 2010;62:35-43.
  • Arslan M, Işık B, Ünal Y, Nurlu N, Özköse Z, Çomu FM, et al. Ef- fects of sevoflurane and desflurane on oxidant/antioxidant status of young versus old rat liver tissues. J Anim Vet Adv 2008;7:1345-51.
  • Morgan GE, Mikhail MS, Murray MJ. Hepatic physiology and anesthesia In: Clinical Anesthesiology. 3rd ed. McGraw-Hill Com- panies. 2002, pp;708–22.
  • Richter S, Olinger A, Hildebrandt U, Menger MD, Vollmar B. Loss of physiologic hepatic blood flow control (“hepatic arterial buffer response”) during CO2- pneumoperitoneum in the rat. Anesth Analg 2001;93:872-7.
  • Sato K, Kawamura T, Wakusawa R. Hepatic blood flow and func- tion in elderly patients undergoing laparoscopic cholecystectomy. Anesth Analg 2000;90:1198-202.
  • Tan M, Xu FF, Peng JS, Li DM, Chen LH, Lv BJ, et al. Changes in the level of serum liver enzymes after laparoscopic surgery. World J Gastroenterol 2003;9:364-7.
  • Patel SS and Goa KL. Desflurane:A review of its pharmacodynamic and pharmacokinetic properties and its efficacy in general anaest- hesia. Drugs 1995;50:742–67.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Case Report
Yazarlar

Mustafa Arslan Bu kişi benim

Ramazan Çiçek Bu kişi benim

Yayımlanma Tarihi 1 Ocak 2012
Yayımlandığı Sayı Yıl 2012 Cilt: 22 Sayı: 4

Kaynak Göster

Vancouver Arslan M, Çiçek R. Desfluran anestezisi sonrası karaciğer toksisitesi: olgu sunumu ve gözden geçirme. Genel Tıp Derg. 2012;22(4):130-4.