Chloroform Anåsthesia in Obstetrics its Effect on the Serum Activity of Ornithine Carbamyl Transferase, Glutamic Oxalacetic Transaminase, and Glutamic Pyruvic Transaminase

Abstract

Chloroform has been one of the most commonly used anaesthetics for almost a century. I n the last fifty years, however, its use has been greatly restricted because of serious side-effects. These may be immediate (cardiac arrhythmia) o r late (degenerative changes in certain organs, particularly the liver). Nowadays, the use of chloroform anaesthesia is almost restricted to obstetric practice and it is then only used in small doses towards the end of the second stage of labour. In Sweden chloroform anzsthesia is rarely used outside the teaching hospitals (af G e i j e r s t a m and L i n d g r e n , 1960).I n experiments on mice, P l a a ef al. (1958) determined the relative hepatotoxicity of chloroform and carbon tetrachloride injected subcutaneously and reported that the effective dose (ED,,) of chloroform was about three times greater than that of carbon tetrachloride. M y r e n (1956) observed histological changes in the liver cells of mice following subcutaneous injection

Serum enzyme changes after major lung surgery--with and without halothane

“…DURATION OF EXPOSURE Although some workers have found digturbances of serum enzymes after a very short exposure to chloroform (Fote, 1960;Reichard et al, 1960) not all accept this. Most of the cases of serum enzyme disturbance which have followed the administration of this agent have occurred after administrations lasting an hour or more (Glover, 1961), as indeed have many cases of acute yellow atrophy (Siebecker and Orth, 1956).…”

“…The latter was used by Tornetta and Boger (1964), who observed some increases in the postoperative period in those anaesthetized with the aid of nitrous oxide, droperidol, and fentanyl. Reichard et al (1960) …”

“…TIMING OF THE TESTS Fote (1960) and Reichard et al (1960) had shown that, following the administration of chloroform for delivery, there is a rise in the concentration of serum enzymes derived from the liver, possibly the result of cellular autolysis, within 48 hours. A previous study (Hunter, 1964) had shown little or no rise in SGOT or SGPT 48 hours after 15 neurosurgical operations with or without hypothermia involving the administration of trimetaphan and/ or halothane to the point of producing an arterial pressure of 50 mm.…”

“…A certain amount of work in this field has already been carried through (Ayres and Williard, 1960; Lawrence and Schulkins, 1956), including enzyme studies on patients to whom chloroform had been given (Fote, 1960;Reichard, Wiqvist, and Yllner, 1960;Griffiths and Ozguc, 1964;Imray, Kennedy, and Kilpatrick, 1964;Rollason, 1964), and, more recently, studies in patients who had been anaesthetized with halothane (Rollason, 1964;Tornetta and Boger, 1964;Beckman, Brohult, and Reichard, 1966). Most of these studies have been informative up to a limited point, but it clearly emerges that changes in serum transaminase levels in the postoperative period are governed more by the operative procedure than by the anaesthetic agents themselves.…”

The Smaller Halogenated Aliphatic Hydrocarbons

“…Poe & Mayfield (7) used chloroform in 70 patients needing a nonflammable anesthetic with considerable success when attention was paid to these points and care was taken to avoid the use of chloroform in patients with liver disease. Other reports on chloroform in obstetrics were found (8,9,10). EEG and blood pressure correlated well with blood chloroform concentrations in any particular dog (Pearcy et al 11).…”