title: Hepatotoxicity of halogenated inhalational anesthetics.
abstract: BACKGROUND
  Halogenated inhalational anesthetics are currently the most common drugs used for the induction and maintenance of general anesthesia. Postoperative hepatic injury has been reported after exposure to these agents. Based on much evidence, mechanism of liver toxicity is more likely to be immunoallergic. The objective of this review study was to assess available studies on hepatotoxicity of these anesthetics.
  
  
  METHODS
  We searched PubMed, Google Scholar, Scopus, Index Copernicus, EBSCO and the Cochrane Database using the following keywords: "inhalational Anesthetics" and "liver injury"; "inhalational anesthetics" and "hepatotoxicity"; "volatile anesthetics" and "liver injury"; "volatile anesthetics" and hepatotoxicity for the period of 1966 to 2013. Fifty two studies were included in this work.
  
  
  RESULTS
  All halogenated inhalational anesthetics are associated with liver injury. Halothane, enflurane, isoflurane and desflurane are metabolized through the metabolic pathway involving cytochrome P-450 2E1 (CYP2E1) and produce trifluoroacetylated components; some of which may be immunogenic. The severity of hepatotoxicity is associated with the degree by which they undergo hepatic metabolism by this cytochrome. However, liver toxicity is highly unlikely from sevoflurane as is not metabolized to trifluoroacetyl compounds.
  
  
  CONCLUSIONS
  Hepatotoxicity of halogenated inhalational anesthetics has been well documented in available literature. Halothane-induced liver injury was extensively acknowledged; however, the next generation halogenated anesthetics have different molecular structures and associated with less hepatotoxicity. Although anesthesia-induced hepatitis is not a common occurrence, we must consider the association between this disorder and the use of halogenated anesthetics.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Saeid
authors.initials: S
authors.lastname: Safari
authors.affiliation: Department of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, IR Iran ; Department of Molecular Hepatology, Middle East Liver Disease Center, Tehran, IR Iran.
authors.forename: Mahsa
authors.initials: M
authors.lastname: Motavaf
authors.affiliation: Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Seyed Alireza
authors.initials: SA
authors.lastname: Seyed Siamdoust
authors.affiliation: Department of Molecular Hepatology, Middle East Liver Disease Center, Tehran, IR Iran ; Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
authors.forename: Seyed Moayed
authors.initials: SM
authors.lastname: Alavian
keywords: Anesthesiology; Halothane; Inhalation Anesthesia; Liver Injury Drug-Induced; Sevoflurane