Hepatic injury associated with halogenated anaesthetics: cross-sensitization and its clinical implications

Mikatti, N. El; Healy, T.E.J.

doi:10.1046/j.1365-2346.1997.00067.x

Cited by 4 publications

(3 citation statements)

References 50 publications

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“…There is also concern that long-term trace-level exposure to these agents may affect the lymphatic systems (causing immunosuppression and/or genetic damage) of operating theatre personnel (Hoerauf et al 1999; Bargellini et al 2001). Although no clear cause-effect relationship has been found for long-term exposure to N 2 O or halide agents (Byhahn et al 2001b) except for halothane, which causes liver injury and is teratogenic at high levels (Mikatti and Healy 1997;Baeder and Albrecht 1990), most public health authorities in Western countries provide occupational exposure recommendations in order to minimise possible health risks (Duvaldestin et al 1981;Edling 1982;Pezzagno et al 1989). For example, the US National Institute for Occupational Safety and Health (1977) recommends that no worker be exposed to 8-h time-weighted average (TWA) concentrations above 25 ppm of N 2 O, or above 2 ppm of any halogenated anaesthetic agent used in isolation, or above 0.5 ppm if the halide is used in combination with N 2 O.…”

Section: Introductionmentioning

confidence: 99%

Proposal for single and mixture biological exposure limits for sevoflurane and nitrous oxide at low occupational exposure levels

Accorsi

Valenti

Barbieri

et al. 2003

Int Arch Occup Environ Health

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Objectives: Assessment of individual exposures to sevoflurane plus nitrous oxide (N 2 O) by biological monitoring of unmodified analytes in post-shift urine of exposed personnel. Methods: Anaesthetics in urine and breathing area were monitored in 124 subjects in 11 operating theatres. Passive samplers were collected after 2.5-7 h of exposure, at the same time as post-shift urinary samples, to evaluate the individual timeweighted average (TWA) exposures to sevoflurane and N 2 O. A static headspace sampler coupled with a gas chromatograph mass spectrometer was used for analytical determinations (sensitivity sufficient to reveal biological/environmental exposures of 0.1 lg/l urine and 50 ppb for sevoflurane, and 1 lg/l urine and 80 ppb for N 2 O). Results: Median (range) post-shift urinary and environmental values were 1.2 lg/l urine (0.1-5.0) and 0.4 ppm (0.05-3.0) for sevoflurane (n=107) and 10.9 lg/ l urine (0.5-74.9) and 8.6 ppm (0.2-123.4) for N 2 O (n=121) (all low-exposure range). At log-log regression, urinary levels closely correlated with environmental data (sevoflurane, r 2 =0.7538; N 2 O, r 2 =0.8749). Biological equivalent limits (BELs) based on National Institute for Occupational Safety and Health (NIOSH) TWA exposure limits, calculated as means of regression slope and y-intercept, were 3.6 lg/l urine for sevoflurane (corresponding to 2 ppm) and 22.3 lg/l urine for N 2 O (corresponding to 25 ppm). Individual ''mixture BELs'', which we calculated by applying the American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit value (TLV)mix formula to biomarker values and using the obtained NIOSH-based BELs as a reference, closely correlated with mixture TLVs (q=0.816, Lin's concordance test). Conclusions: We propose urinary sevoflurane as a new, specific, internal dose biomarker for routine biological monitoring of personal exposures among operating-theatre personnel, and use of reliable ''mixture BELs'' to provide safer levels of internal exposure for workers exposed to mixtures of sevoflurane and N 2 O, and conceivably also to other mixtures of toxicants with possible additive effects.

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Section: Introductionmentioning

confidence: 99%

Proposal for single and mixture biological exposure limits for sevoflurane and nitrous oxide at low occupational exposure levels

Accorsi

Valenti

Barbieri

et al. 2003

Int Arch Occup Environ Health

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“…These findings suggest that isoflurane has low (Not null) immunologic properties. Some concerns have arisen following reports following isoflurane administration in those who had previously received halothane or enflurane ( 50 ).…”

Section: Resultsmentioning

confidence: 99%

The Role of Inhalational Anesthetic Drugs in Patients with Hepatic Dysfunction: A Review Article

et al. 2015

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Context:Anesthetic drugs including halogenated anesthetics have been common for many years. Consequent hepatic injury has been reported in the literature. The mechanism of injury is immunoallergic. The first generation drug was halothane; it had the most toxicity when compared to other drugs. The issue becomes more important when the patient has an underlying hepatic dysfunction.Evidence Acquisition:In this paper, reputable internet databases from 1957–2014 were analyzed and 43 original articles, 3 case reports, and 3 books were studied. A search was performed based on the following keywords: inhalational anesthesia, hepatic dysfunction, halogenated anesthetics, general anesthesia in patients with hepatic diseases, and side effects of halogenated anesthetics from reliable databases. Reputable websites like PubMed and Cochrane were used for the searches.Results:In patients with hepatic dysfunction in addition to hepatic system and dramatic hemostatic dysfunction, dysfunction of cardiovascular, renal, respiratory, gastrointestinal, and central nervous systems may occur. On the other hand, exposure to inhalational halogenated anesthetics may have a negative impact (similar to hepatitis) on all aforementioned systems in addition to direct effects on liver function as well as the effects are more pronounced in halothane.Conclusions:Despite the adverse effects of inhalational halogenated anesthetics (especially halothane) on hepatic patients when necessary. The effects on all systems must be considered and the necessary preparations must be provided. These drugs are still used, if necessary, due to the presence of positive effects and advantages mentioned in other studies as well as the adverse effects of other drugs.

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“…Unlike other anesthetic gases, sevoflurane does not have a reactive metabolite in its metabolic pathway, thus reducing the risk of hepatotoxicity [ 11 ]. TFA derivatives are required to create neoantigens.…”

Section: Discussionmentioning

confidence: 99%

Fulminant Hepatic Failure in the Course of an Outpatient Anesthetic Procedure: Sevoflurane among Other High-Risk Factors

Cheron

Hoet

Renard

et al. 2020

Case Reports in Anesthesiology

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A 20-year-old man underwent an outpatient general anesthetic procedure with sevoflurane for the correction of a bilateral gynecomastia. The patient had been first exposed to sevoflurane two years before, without any complication. He presented an overweight with a body mass index (BMI) of 31.4 kg/m2 and had an episode of “binge” drinking a few days before anesthesia. He became icteric from postoperative day 9, and after the worsening of liver function tests, the liver biopsy revealed centrilobular necrosis. The patient became encephalopathic and required urgent liver transplantation on postoperative day 30. The possibility of a sevoflurane-related fulminant hepatic failure is discussed.

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Hepatic injury associated with halogenated anaesthetics: cross-sensitization and its clinical implications

Cited by 4 publications

References 50 publications

Proposal for single and mixture biological exposure limits for sevoflurane and nitrous oxide at low occupational exposure levels

Proposal for single and mixture biological exposure limits for sevoflurane and nitrous oxide at low occupational exposure levels

The Role of Inhalational Anesthetic Drugs in Patients with Hepatic Dysfunction: A Review Article

Fulminant Hepatic Failure in the Course of an Outpatient Anesthetic Procedure: Sevoflurane among Other High-Risk Factors

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