Is nitrous oxide, enflurane, or isoflurane hepatotoxic?
Nitrous oxide has largely escaped implications as being hepatotoxic. However, the incidence of hepatic injury following halothane exposure is 1:35,000 for primary expo-sure and increases to 1:3,700 for patients with repeated exposures. Hepatic injury following enflurane exposure has a strikingly lower incidence approaching 1:800,000. These rare cases of hepatic injury following enflurane administration can present with histologic patterns similar to hypoxic injury in laboratory studies. There have been reports of fatal hepatitis after exposure to enflurane where anti-TFA antibodies have been found in the patient‚Äôs sera. Examples of possible cross-sensitization reactions between halothane and enflurane, isoflurane, or desflurane have been reported. Isoflurane presents an even lower incidence of posthepatic necrosis. The reason for this is probably related to its much lower level of metabolism.