The Role of Anesthetic Drugs in Liver Apoptosis

Dabbagh, Ali; Rajaei, Samira

doi:10.5812/hepatmon.13162

Cited by 19 publications

(10 citation statements)

References 141 publications

(127 reference statements)

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“…This is in contrast to previous anesthetics, where TFA is detectable in urine for up to 12 days after 75 minutes of anesthesia ( 41 - 43 ). However, sevoflurane has a low hepatotoxic potential as described in the current available literature ( 8 , 44 , 45 ). As apparently, sevoflurane is unlikely to cause severe postoperative hepatic injury and is an ideal anesthetic for patients with previous exposure to other halogenated anesthetics or hepatic disease ( 46 - 48 ).…”

Section: Resultsmentioning

confidence: 91%

“…Within a few years of its introduction, cases of halothane-induced liver injuries were reported. In 1969, the National Institutes of Health (NIH) organized an epidemiological study on 250000 cases of halothane administration, which revealed an incidence of fatal hepatic necrosis of about 1 in 35000 individuals ( 6 - 8 ). Concerns about its hepatotoxicity eliminated the use of this anesthetic for adults in the United States and many other countries.…”

Section: Resultsmentioning

confidence: 99%

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Hepatotoxicity of Halogenated Inhalational Anesthetics

Safari¹,

Motavaf²,

Siamdoust³

et al. 2014

Iran Red Crescent Med J

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Context: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.Evidence Acquisition: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.

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Hepatotoxicity of Halogenated Inhalational Anesthetics

Safari¹,

Motavaf²,

Siamdoust³

et al. 2014

Iran Red Crescent Med J

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show abstract

“…Based on the literature, halothane and sevoflurane have been reported as volatiles with the most and least associated complications, respectively ( 13 , 30 ).…”

Section: Resultsmentioning

confidence: 99%

“…Anesthesia is a modern intervention that was first introduced in 1846 ( 13 - 16 ). Ether and chloroform were used as anesthetic agents before the 1950s, despite awareness of numerous side effects.…”

Section: Contextmentioning

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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“…Isoflurane undergoes minimal biotransformation; however, a wide spectrum of hepatotoxicity ranging from transaminitis to fulminant hepatic failure induced by isoflurane has been observed (5)(6)(7)(8). It has been demonstrated that the oxidative stress response, and hepatic necrosis and apoptosis, are involved in the liver injury mechanism (9,10); however, the exact mechanisms underlying this action have not been elucidated.…”

Section: Introductionmentioning

confidence: 99%

Isoflurane anesthesia induces liver injury by regulating the expression of insulin-like growth factor 1

Zhu

Xiao

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. It has been suggested that isoflurane may cause perioperative liver injury. However, the mechanism of its action remains unknown. The purpose of the present study was to determine this possible mechanism. Sprague-Dawley rats were randomly assigned into one of three groups (all n=12): Control group (exposed to mock anesthesia), isoflurane group (exposed to 2% isoflurane for 90 min), and isoflurane + insulin-like growth factor 1 (IGF-1) group (exposed to 2% isoflurane for 90 min and then treated with IGF-1). Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and western blotting were conducted to determine the levels of expression of IGF-1 and its receptor IGF-R. Liver necrosis was assessed by histological examination. TUNEL assay was performed to determine the apoptosis of hepatic cells. In addition, the levels of the proteins caspase-3 and B-cell lymphoma-extra large (Bcl-xL) were measured. Compared with the control group, levels of IGF-1 and IGF-1R mRNA and protein were significantly decreased following exposure to isoflurane (all P<0.05). The necrosis rate and liver apoptosis were significantly increased in the group treated with isoflurane alone compared with the control group (P<0.05), but were significantly decreased compared with the isoflurane group following application of IGF-1 (P<0.05). Additionally, isoflurane exposure significantly increased levels of caspase-3 compared with the control group (P<0.05), but decreased levels of Bcl-xL (P<0.05). By contrast, application of IGF-1 reversed these changes. The present study therefore suggests that isoflurane induces liver injury in part by regulating the expression of IGF-1 and that application of IGF-1 may protect against liver injury induced by isoflurane exposure.

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The Role of Anesthetic Drugs in Liver Apoptosis

Cited by 19 publications

References 141 publications

Hepatotoxicity of Halogenated Inhalational Anesthetics

Hepatotoxicity of Halogenated Inhalational Anesthetics

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

Isoflurane anesthesia induces liver injury by regulating the expression of insulin-like growth factor 1

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