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Canadian Journal of Anaesthesia

, Volume 45, Issue 8, pp 753–756 | Cite as

Liver function after sevoflurane or isoflurane anaesthesia in neurosurgical patients

  • Tomoki Nishiyama
  • Takeshi Yokoyama
  • Kazuo Hanaoka
Reports of Investigation

Abstract

Purpose

Although both sevoflurane and isoflurane are thought to be less hepatotoxic than halothane or enflurane, recent case reports have described liver injury after sevoflurane or isoflurane anaesthesia. There are no studies comparing liver function after sevoflurane or isoflurane anaesthesia. The purpose of this study was to compare serum liver enzyme concentrations in patients receiving either sevoflurane or isoflurane anaesthesia prospectively.

Methods

Ninety patients scheduled for elective neurosurgery were studied. Serum concentrations of aspartame aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBil), alkaline phosphatase (ALP), γ- glutamyl transpeptidase (GTP), and lactate dehydrogenase (LDH) were measured before and, 1, 2, 3, 7, and 14 days after either sevoflurane (45 patients) or isoflurane (45 patients) anaesthesia.

Results

AST ALT and GTP increased peaking seven days after anaesthesia, especially in the isoflurane group. The numbers of patients with abnormal values in AST and ALT were not different in the isoflurane from that in the sevoflurane group. The increase in TBil peaked one day after anaesthesia in both groups.

Conclusion

Even in a small number of patients, isoflurane induced an elevation of serum levels of liver enzymes more frequently than did sevoflurane three to 14 days after anaesthesia.

Keywords

Isoflurane Halothane Sevoflurane Enflurane Aspartame 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

Quoique le sévoflurane et l’isoflurane soient censés être moins hépatotoxiques que l’halothane ou l’enflurane, on a rapporté de récents cas de lésion hépatique à la suite d’anesthésie avec le sévoflurane ou l’isoflurane. Aucune étude comparative de la fonction hépatique n’a été faite après une anesthésie avec le sévoflurane ou l’isoflurane. L’objectif de la présente étude était de comparer de façon prospective les concentrations sériques d’enzymes hépatiques chez les patients qui ont reçu une anesthésie avec le sévoflurane ou l’isoflurane.

Méthode

Quatre-vingt-dix patients devant subir une neurochirurgie élective ont participé à l’étude. Les concentrations sériques d’aspartate-aminotransférase (AST), d’alanine-aminotransférase (ALT), de bilirubine totale (BilT), de phosphatase alcaline (PAL), de γ-glutamyl transpeptidase (GTP) et de lactate-déshydrogénase (LDH) ont été mesurées avant l’anesthésie, puis 1, 2, 3, 7 et 14 jours après l’anesthésie avec le sévoflurane (45 patients) ou avec l’isoflurane (45 patients).

Résultats

LAST l’ALT et la GTP ont augmenté, surtout dans le groupe de l’isoflurane, avec une concentration maximale sept jours après l’anesthésie. Le nombre de patients présentant des valeurs anormales d’AST et d’ALT n’était pas différent selon les groupes d’isoflurane ou de sévoflurane. L’augmentation de BilT était à son maximum un jour après l’anesthésie dans les deux groupes.

Conclusion

Même dans un petit groupe de patients, l’isoflurane provoque une élévation des niveaux sériques d’enzymes hépatiques selon une plus grande fréquence que ne le fait le sévoflurane de 3 à 14 jours après l’anesthésie.

References

  1. 1.
    Tsujimoto S, Kato H, Minamoto Y, Miki H, Kitamura R. Comparison of postoperative liver dysfunction following halothane and sevoflurane anesthesia in women undergoing mastectomy for cancer. Journal of Anesthesia 1995; 9: 129–34.CrossRefGoogle Scholar
  2. 2.
    Hussey AJ, Aldridge LM, Paul D, Ray DC, Beckett GJ, Allan LG. Plasma glutathione S-transferase concentration as a measure of hepatocellular integrity following a single general anaesthetic with halothane, enflurane or isoflurane. Br J Anaesth 1988; 60: 130–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Shichinohe Y, Masuda T, Takahashi H. A case of postoperative hepatic injury after sevoflurane anesthesia. Jpn J Anesthesiol 1992; 41: 1802–5.Google Scholar
  4. 4.
    Watanabe K, Hatakenaka S, Ikemune K. A case of suspected liver dysfunction induced by sevoflurane anesthesia. Jpn J Anesthesiol 1993; 42: 902–5.Google Scholar
  5. 5.
    Brunt EM, White H, Marsh JW, Holtmann B, Peters MG. Fluminant hepatic failure after repeated exposure to isoflurane anesthesia: a case report. Hepatology 1991; 13: 1017–21.PubMedCrossRefGoogle Scholar
  6. 6.
    Weitz J, Kienle P, B’hrer H, Hofmann W, Theilmann L, Otto G. Fatal hepatic necrosis after isoflurane anaesthesia. Anaesthesia 1997; 52: 892–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Iaizzo PA, Seewald MJ, Powis G, Phil D, Van Dyke RA. The effects of volatile anesthetics on Ca++ mobilization in rat hepatocytes. Anesthesiology 1990; 72: 504–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Lind RC, Gandolfi AJ, Hall PM. Covalent binding of oxidative biotransformation intermediates is associated with halothane hepatotoxicity in guinea pigs. Anesthesiology 1990; 73: 1208–13.PubMedCrossRefGoogle Scholar
  9. 9.
    Hitt BA, Mazze RI, Cousins MJ, Edmunds HN, Barr GA, Trudell JR. Metabolism of isoflurane in Fischer 344 rats and man. Anesthesiology 1974; 40: 62–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Holaday DA, Smith FR. Clinical characteristics and biotransformation of sevoflurane in healthy human volunteers. Anesthesiology 1981; 54: 100–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Goldfarb G, Debaene B, Ang ET, Roulot D, Jolis P, Lebrec D. Hepatic blood flow in humans during isoflurane — N2O and halothane — N2O anesthesia. Anesth Analg 1990; 71: 349–53.PubMedCrossRefGoogle Scholar
  12. 12.
    Fujita Y, Kimura K, Hamada H, Takaori M. Comparative effects oh halothane, isoflurane, and sevoflurane on the liver with hepatic artery ligation in the beagle. Anesthesiology 1991; 75: 313–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Manohar M, Parks CM. Porcine systemic and regional organ blood flow during 1.0 and 1.5 minimum alveolar concentrations of sevoflurane anesthesia without and with 50% nitrous oxide. J Pharmacol Exp Ther 1984; 231: 640–8.PubMedGoogle Scholar
  14. 14.
    Bernard JM, Doursout MF, Wouters P, Hartley CJ, Merin RG, Chelly JE. Effects of sevoflurane and isoflurane on hepatic circulation in the chronically instrumented dog. Anesthesiology 1992; 77: 541–5.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1998

Authors and Affiliations

  • Tomoki Nishiyama
    • 1
  • Takeshi Yokoyama
    • 2
  • Kazuo Hanaoka
    • 1
  1. 1.Department of AnesthesiologyThe University of Tokyo, Faculty of MedicineTokyoJapan
  2. 2.Department of Anesthesiology and ResuscitologyKochi Medical CollegeKochiJapan

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