Desfluran anestezisi sonrası karaciğer toksisitesi: olgu sunumu ve gözden geçirme

Geleneksel inhalasyon anestezik ajanların ılımlı ve bazen de şiddetli karaciğer yetmezliğine yol açtıkları müşahade edilmiştir. Ancak yeni inhalasyon ajanları primer hepatotoksisitenin nedeni olarak kabul edilemezler. Bu olgu sunumunda laparoskopik kolesistektomi planlanan hipertansiyonu, peptik ülseri ve hiperlipidemisi olan ASA II, 65 yaşında kadın hastada desflurana bağlı karaciğer yetmez- liğini tanımladık. Preoperatif laboratuar değerleri normaldi. Operasyon esnasında, midazolam, remifentanil, sodyum tiyopental ve vekuronyum devamında da desfluran anestezisi uygulandı. Peroperatif 4L CO2 ile CO2 insuflasyon basıncı 15 mmHg'da tutuldu. Per operatif hastanın hemodinamik parametreleri stabil olarak dökümante edildi. Laparoskopik kolesistektomi operasyonu 135 dakika sürdü. Serum alanin aminotransferaz ve aspartat aminotransferaz düzeyi postoperatif 2. günde sırasıyla 711 ve 621 U/L idi. Karaciğer enzimleri postoperatif 13. günde normale döndü ve hasta 15. günde taburcu edildi. Biz hepatotoksisiteyi bir önceki anestezi uygu- lanması sonrası, operasyonda uygulanan desfluran ile ilişkilendiriyoruz. Gelecekte hasta anestezi alacaksa total intravenöz anestezi uygulanabilir

Hepatotoxicity following desflurane anesthesia: a case report and review

It has been well established that traditional inhalational anaesthetic agents can cause mild and sometimes fulminant liver failure. However, while newer inhalational agents are a theoretical cause of hepatotoxicity. We describe desflurane-induced acute liver failure in a 65-year-old woman with hypertension, peptic ulcus, and hyperlipidaemia. The patient (ASAII) was scheduled for laparoscopic cholecystectomy. Her preoperative laboratory findings were normal. In the laparoscopic cholecystectomy operation anesthesia was induced with midazolam, remifentanil, sodium thiopental and vecuronium and maintained with desflurane anesthesia. The CO2 insuflation pressure was kept at 15 mmHg with peroperative 4L CO2 . Perioperatively the patient was stable with documented hemodynamic parameters, laparoscopic cholecystectomy operation was 135 minutes. Serum alanine aminotransferase and aspartate aminotransferase peaked at postoperative day two (711 and 621 U/L, respectively). The liver biochemistry normalized completely by postoperative day 13 and the patient was discharged from hospital on postoperative day 15. We believe this to be a case of hepatotoxicity related to desflurane exposure after previous exposure to anesthesia. In the future, this patient will receive total intravenous anesthesia.

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