title: Fatal subacute liver failure after repeated administration of sevoflurane anaesthesia.
abstract: Sevoflurane is a widely used halogenated inhalation anaesthetic. In comparison with other similar anaesthetics, it is not metabolized to potentially hepatotoxic trifluoroacetylated proteins. In this case report, we present a 66-year-old woman with breast carcinoma, who underwent sevoflurane general anaesthesia twice in 25 days. Soon after the second elective surgical procedure, jaundice and marked elevations in serum transaminases developed. The patient died 66 days thereafter. Autopsy results denied evidence of major cardiovascular abnormality, and histological examination confirmed massive liver cell necrosis with no feature of chronic liver injury. Sevoflurane anaesthesia was imputed as the cause after exclusion of other possible aetiological agents. Besides, coexistent malignant tumours found in the patient could have modulated the immunological response to the applied anaesthetic followed by fatal consequences.
authors: Department of Gastroenterology, University Medical Centre, Zaloska 7, Ljubljana 1000, Slovenia. davidzizek@yahoo.com
authors: David
authors: D
authors: Zizek
authors: Marija
authors: M
authors: Ribnikar
authors: Bogomir
authors: B
authors: Zizek
authors: Vera
authors: V
authors: Ferlan-Marolt
mesh_terms: D000368:Aged; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000601:surgery; D004334:Drug Administration Schedule; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D047508:Massive Hepatic Necrosis / Q000139:chemically induced*; D015412:Mastectomy, Segmental; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects*; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane