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Hepatic Dysfunction after Isoflurane Anesthesia

Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana; Old Pueblo Anesthesia, Ltd., Tucson, Arizona; the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and the University of Texas Health Science Center at Houston, Houston, Texas.

Abstract

Four members of the Anesthetic and Life Support Advisory Committee of the Food and Drug Administration assessed the contribution of isoflurane (Forane®) to 45 instances of hepatic dysfunction after isoflurane anesthesia reported to the FDA for 1981–1984. For 29 (64%) of the cases, at least three members concluded that nonanesthetic causes (e.g., hypoxia, sepsis, viral infection) explained the hepatic injury. For 16 cases (36%), two or more members concluded that isoflurane might be one of several possible causes of the hepatic injury. In the latter cases, patients tended to be younger, had undergone anesthesia of shorter duration for operations outside the chest and abdomen, had developed symptoms later, had higher plasma transaminase values but lower bilirubin values, and had a lower incidence of eosinophilia, anemia, transfusions, and congestive heart failure. The committee concluded that current evidence does not indicate a reasonable likelihood of an association between the use of isoflurane and the occurrence of postoperative hepatic dysfunction.

Key Words: ANESTHETICS, volatile—isoflurane. • LIVER—isoflurane effects.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999