Anesth Pain Med.  2016 Apr;11(2):172-175. 10.17085/apm.2016.11.2.172.

Multiple exposures of sevoflurane in a patient with hepatic damage from crushing injuries: A case report

• Kim DY
• Cho HC
• Park SY
• Lee JH
• Lee JH
• Chung CJ

• KMID: 2358480
• DOI: http://doi.org/10.17085/apm.2016.11.2.172

Abstract

Sevoflurane, which has low solubility in blood, facilitates rapid induction and recovery. Sevoflurane is metabolized to hexafluoroisopropanol by cytochrome P450. Hexafluoroisopropanol has significantly less protein binding capability, does not accumulate and rapidly undergoes phase II biotransformation to form Hexafluoroisopropanol glucuronide, which is mostly excreted in the urine within 12 hours. Thus, the hepatotoxic potential of sevoflurane has been considered very low. However, there are many reports about hepatic toxicity after sevoflurane anesthesia. We report a case of a 21-year-old male who had high levels of aspartate transaminase and alanine transaminase with crushing injuries and had low hepatic dysfunction after 29 sevoflurane anesthesia treatments within three months.

Keyword

Hepatotoxicity; Sevoflurane

MeSH Terms

Alanine Transaminase
Anesthesia
Aspartate Aminotransferases
Biotransformation
Cytochrome P-450 Enzyme System
Humans
Male
Protein Binding
Solubility
Young Adult
Alanine Transaminase
Aspartate Aminotransferases
Cytochrome P-450 Enzyme System

Figure

• 

  Fig. 1 The changes of AST/ALT after crushing injury. The X axis is postinjury day and airway mode in anesthesia which is described in Table 1. ETT: endotracheal tube, MAC: monitored anesthetic care, Mask: mask anesthesia. AST: aspartate transaminase, ALT: alanine transaminase.

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