title: Liver function and halothane-diethyl-ether azeotrope anaesthesia. Re-evaluation of an obsolete drug with special reference to early postoperative effects.
abstract: A general anaesthetic drug that fulfils requirements for use under difficult circumstances is the inhalation agent halothane-diethyl-ether (HE) azeotrope. Although both halothane and diethyl ether have been described in detail, their effect on the liver when given together as an azeotrope has not been systematically characterised. The effect on liver function was evaluated and compared with the effects of halothane anaesthesia (H) and spinal anaesthesia with tetracaine (S), the last named serving as controls. The series consisted of 33 healthy men (ASA 1-2) receiving no medication and scheduled for inguinal hernia repair. The patients were randomly allocated to receive HE, H or S. The following parameters were estimated the day before surgery and on the first postoperative day: liver cell metabolism (bile acids, unconjugated bilirubin), cell integrity (aminotransferases), synthesizing capacity (Prothrombin complex), cholestasis (conjugated bilirubin, alkaline phosphatase, gamma-glutamyl transpeptidase), and global liver function (chenodeoxycholic load test). No major differences emerged between the groups. Unconjugated bilirubin was increased in all groups. Prothrombin complex activity was reduced in all groups. Conjugated bilirubin was increased in the H group. The oral bile acid load test and the fasting bile acid were unaltered by anaesthesia in all groups. No major impact on liver cell function was seen in the early post-operative period after HE azeotrope anaesthesia. The findings support our view that HE azeotrope could be considered as an alternative anaesthetic agent under field conditions.
authors.affiliation: Department of Anaesthesiology, University Hospital, Linköping, Sweden.
authors.forename: S H
authors.initials: SH
authors.lastname: Kalman
authors.forename: M
authors.initials: M
authors.lastname: Bengtsson
authors.forename: J
authors.initials: J
authors.lastname: Mårtensson
mesh_terms: D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation; D000775:Anesthesia, Spinal; D001647:Bile Acids and Salts / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002779:Cholestasis / Q000097:blood / Q000139:chemically induced; D004338:Drug Combinations; D004986:Ether / Q000008:administration & dosage / Q000494:pharmacology*; D006221:Halothane / Q000008:administration & dosage / Q000494:pharmacology*; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000378:metabolism / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011516:Prothrombin / Q000378:metabolism; D013748:Tetracaine / Q000008:administration & dosage / Q000494:pharmacology; D000637:Transaminases / Q000097:blood
chemical_list: D001647:Bile Acids and Salts; D004338:Drug Combinations; D013748:Tetracaine; D004986:Ether; D011516:Prothrombin; D000637:Transaminases; D001663:Bilirubin; D006221:Halothane