1/3. Fatal hepatotoxicity after re-exposure to isoflurane: a case report and review of the literature.A 76-year-old Caucasian woman developed fulminant hepatic necrosis 6 days after an uneventful operation under isoflurane anaesthesia. Laboratory findings included elevated bilirubin, grossly elevated transaminases and prolonged prothrombin time. Radiological investigation showed no evidence of extra-hepatic disease. Serological studies were negative for acute viral hepatitis and autoimmune disease. The patient may have been previously sensitized by exposure to isoflurane 3 years previously but antibodies to tri-fluoro acetate, present in 70% of cases of halothane hepatitis, were not detected in pre-operative or postoperative samples of blood. On the seventh postoperative day the patient died and postmortem examination demonstrated centrilobular necrosis of the liver, with a histological pattern similar to changes associated with halothane hepatitis.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Use of regional anaesthesia in a patient with acute porphyria.The porphyrias are inherited disorders of haem metabolism, acute attacks of which may be precipitated by anaesthesia, surgery and pregnancy. The principal clinical feature of the disease is an acute neuropathy. A patient with acute intermittent porphyria was given bupivacaine as part of a regional anaesthetic for Caesarean section. The course of anaesthesia was uneventful.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |
3/3. Is propofol a safe agent in porphyria?A case is presented of the use of a propofol infusion for anaesthesia in a patient with known variegate porphyria. Urinary screening for porphyrins demonstrated a marked increase after this anaesthetic, but there were no clinical symptoms.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |