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Volatile Anesthetics : Organ Toxicity
Case Synopsis
A 53-year-old woman has laser excision of vocal cord papillomas under anesthesia with halothane and spontaneous ventilation. She has had several prior excisions, including one a month earlier, all with halothane; all were uneventful. However, 1 week after this surgery, she develops fever, nausea, and malaise, along with severe jaundice and markedly elevated serum transaminase concentrations.
Problem Analysis
Definition
Organ toxicity caused by volatile anesthetics is the result of alterations in cellular structure or function that persist beyond the period of anesthetic administration and elimination. Of greatest concern with volatile anesthetics are hepatic toxicity and renal toxicity.
Not discussed here, but worthy of mention, is the potential for volatile inhalational anesthetics to interact with desiccated carbon dioxide absorbents to form potentially toxic compounds, such as carbon monoxide and compound A. Pulmonary and renal toxicity can occur, and fires and explosions have also been reported. (For more details, see the works by Baum and Woehlck listed under “Further Reading.”)
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