title: Severe desflurane hepatotoxicity after colon surgery in an elderly patient.
abstract: OBJECTIVE
  To report a case of desflurane hepatotoxicity.
  
  
  METHODS
  An 81-yr-old woman with a remote history of abdominal surgery developed severe acute liver injury after general anesthesia with desflurane for resection of colonic cancer. Serum alanine aminotransferase and aspartate aminotransferase peaked at postoperative day six (2188 and 425 U*L(-1) respectively), with the development of coagulopathy with an international normalized ratio of 2.29 on postoperative day eight, progressive jaundice with a peak serum total bilirubin of 214 mumol*L(-1) on postoperative day 12 and hepatic encephalopathy on postoperative day ten. Other causes for liver disease were excluded. Treatment with corticosteroids was started. The liver biochemistry normalized completely by postoperative day 30 and the patient was discharged from hospital on postoperative day 21.
  
  
  CONCLUSIONS
  To our knowledge, this represents only the third report of desflurane hepatotoxicity and the first with reversible fulminant liver failure. Our experience suggests that all fluorinated anesthetics may cause acute hepatic damage.
authors.affiliation: Vancouver General Hospital, Division of Gastroenterology, 100-2647 Willow Street, Vancouver, B.C. V5Z 3P1, Canada.
authors.forename: Dean
authors.initials: D
authors.lastname: Tung
authors.forename: Eric M
authors.initials: EM
authors.lastname: Yoshida
authors.forename: Charlie S K
authors.initials: CS
authors.lastname: Wang
authors.forename: Urs P
authors.initials: UP
authors.lastname: Steinbrecher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000769:Anesthesia, Inhalation / Q000009:adverse effects*; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000201:enzymology / Q000209:etiology*; D003106:Colon / Q000601:surgery*; D000077335:Desflurane; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000009:adverse effects* / Q000031:analogs & derivatives*; D008099:Liver / Q000201:enzymology; D008111:Liver Function Tests
chemical_list: D018685:Anesthetics, Inhalation; D000077335:Desflurane; D007530:Isoflurane