Case report: Fatal hepatic failure after aortic valve replacement and sevoflurane exposure View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2007-11

AUTHORS

Andreas Lehmann, Michael Neher, Arndt-Holger Kiessling, Frank Isgro, Anette Koloska, Joachim Boldt

ABSTRACT

PurposeTo report a case of lethal hepatotoxicity possibly caused by sevoflurane.Clinical featuresA 76-yr-old woman with a history of four previous minor surgical procedures developed acute liver failure after general anesthesia with sevoflurane, sufentanil and propofol for aortic valve replacement. After an uneventful procedure the patient was extubated 4.5 hr after surgery. On the second postoperative day, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increased. On the third postoperative day liver failure occurred, ALT peaked at 10504 U·L-1 and AST at 15516 U·L-1, and coagulopathy with an international normalized ratio of 4.6 developed. Liver transplantation was considered but rejected as a therapeutic option. The patient died three days after the operation in multiple organ failure triggered by hepatic failure. Other possible causes for liver failure were excluded.ConclusionsSevoflurane hepatitis as a cause for liver failure may be implicated in this patient undergoing valve surgery. Unlike other halogenated anesthetic drugs, sevoflurane is not metabolized to hepatotoxic trifluroacetyl proteins. However, compound A may react with proteins and may be transformed into antigenic material. We suggest that all halogenated anesthetics may be implicated with acute liver injury. More... »

PAGES

917

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/bf03026797

DOI

http://dx.doi.org/10.1007/bf03026797

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1014524403

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/17975238


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