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PubMed1998

Liver function after sevoflurane or isoflurane anaesthesia in neurosurgical patients.

PURPOSE: Although both sevoflurane and isoflurane are thought to be less hepatotoxic than halothane or enflurane, recent case reports have described liver injury after sevoflurane or isoflurane anaesthesia. There are no studies comparing liver function after sevoflurane or isoflurane anaesthesia. The purpose of this study was to compare serum liver enzyme concentrations in patients receiving either sevoflurane or isoflurane anaesthesia prospectively. METHODS: Ninety patients scheduled for elective neurosurgery were studied. Serum concentrations of aspartame aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBil), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GTP), and lactate dehydrogenase (LDH) were measured before and, 1, 2, 3, 7, and 14 days after either sevoflurane (45 patients) or isoflurane (45 patients) anaesthesia. RESULTS: AST, ALT and GTP increased peaking seven days after anaesthesia, especially in the isoflurane group. The numbers of patients with abnormal values in AST and ALT were not different in the isoflurane from that in the sevoflurane group. The increase in TBil peaked one day after anaesthesia in both groups. CONCLUSION: Even in a small number of patients, isoflurane induced an elevation of serum levels of liver enzymes more frequently than did sevoflurane three to 14 days after anaesthesia.

Aged↗
PubMed1990

[Clinical study on arterio-venous differences in clinical biochemical assay for infants and children at induction of general anesthesia (Enflurane-N2-O-O2). First report: liver function tests].

The arterial blood is often drawn during general anesthesia to measure many biochemical parameters, and, outside the operative period, those parameters are measured mainly in the venous blood. In this way, the A-V differences (the differences between the data from the arterial blood and those from the venous blood) will be found. However, there are few reports about the A-V difference in infants and children. The purpose of this investigation was to compare the arterial blood data with the venous data at the induction of general anesthesia (Enflurane-N2O-O2). In this report, Plasma total bilirubin concentration (by the Michaëlson method), GOT activity, GPT activity (by the Karmen method), gamma-GTP activity (by the gamma-glutamyl CPA substrate method) and pseudocholinesterase activity (by the Shibata-Takahashi method) were measured with both the arterial (from the radial Artery) and the venous samples (from the saphena Magna), in 60 cases of infants and children who had no systemic disease. They were divided into three groups according to age. (Group I: three months old to one year old, Group II: one year old to three years old, and Group III: three years old to six years old.) Each group consisted of 20 patients. The difference and correlation coefficients between arterial and venous measurements were analysed with the paired t-test and correlation analysis Fs = [r2(n-2)/(1-r2)]1/2. Additionally, the data was analysed with a one dimensional analysis for all Groups. In the results, the A-V difference was so small that the conclusion was reached that in these liver function tests there would be no problem in regarding arterial measurements as venous measurements.

Alanine Transaminase↗
PubMed1986

Quantitative liver function in the elderly assessed by galactose elimination capacity, aminopyrine demethylation and caffeine clearance.

Hepatic function was assessed in 13 healthy elderly subjects, 71-88 years of age, with three quantitative tests of liver function. The galactose elimination capacity was significantly (P less than 0.05) lower in the elderly (6.08 +/- 1.30 mg X min-1 X kg-1, mean +/- SD) than in a group of 70 subjects under 40 (7.48 +/- 0.94 mg X min-1 X kg-1) and 11 subjects between the age of 40 and 70 (7.08 +/- 0.68 mg X min-1 X kg-1). The demethylation of aminopyrine as assessed by the aminopyrine breath test, and the systemic clearance of caffeine, two measures of microsomal function, demonstrated a comparable decrease but showed much more interindividual variation. Caffeine clearance decreased from 1.49 +/- 0.44 ml X min-1 X kg-1 in young adults to 0.97 +/- 0.39 ml X min-1 X kg-1 (P less than 0.01) in the elderly, and the demethylation of aminopyrine decreased from 0.79 +/- 0.15 to 0.62 +/- 0.20% dose X kg X mmol-1 (P less than 0.05). Our data indicate that aging is associated with a loss of the functioning mass of hepatocytes. The decrease in drug metabolism parallels the loss of functional mass but shows more interindividual variation probably reflecting the many genetic and environmental factors influencing these tests of microsomal function.

Adult↗
PubMed1984

Effects of halothane anesthesia on equine liver function.

Effects of halothane anesthesia were investigated in ponies prepared surgically with chronic external biliary fistulas (T tubes) to determine the effects on liver function and biliary excretion during 2 hours of anesthesia. Four studies were performed on 2 ponies, 2 to 6 months after surgery with the enterohepatic circulation held intact between studies. Intravenous bile acid infusion was used to maintain steady-state bile flow, bilirubin, and bile acid excretion during each study. Compared with the immediate 2-hour preanesthesia values (base line), halothane caused a 138% increase in bilirubin excretion, a 60% increase in biliary bilirubin concentration, and a 43% increase in PCV. Halothane anesthesia also caused a 16% reduction in plasma bilirubin, a 46% reduction in biliary bile acid concentration, and a 27% reduction in bile acid excretion. The bile acid independent fraction of bile flow appeared to increase. Plasma aspartate transaminase concentration did not change during anesthesia. The ratio of conjugated bilirubin fractions in bile [82% to 83% disconjugates of glucuronide and glucoside (2 forms) and 17% to 18% monoconjugates of glucoside, glucuronide, and xyloside] did not change during anesthesia and less than 1% was excreted unconjugated. Halothane anesthesia did not appear to affect adversely the activity of the transferase-conjugating enzymes in the presence of an increased bilirubin load. Seemingly, greatly increased conjugated bilirubin excretion observed during halothane anesthesia was most likely the result of a combination of increased hepatic clearance from plasma and increased hepatic bilirubin production from turnover of free hepatic heme or heme from the induced cytochrome P-450 system.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗
PubMed1983

Menopausal estrogen use, high density lipoprotein cholesterol subfractions and liver function.

Forty-eight menopausal women taking exogenous estrogen were compared with 246 postmenopausal women not on estrogen. The estrogen users had significantly higher total high density lipoprotein (HDL) (76.0 vs 61.4 mg/dl) and HDL2 (36.7 vs 23.0 mg/dl) cholesterol than the controls. There was a similar concentration of HDL3 cholesterol for the two groups (39.2 for the estrogen users and 38.4 for the controls). A dose-response was evident between the amount of daily estrogen and HDL-total and HDL2 cholesterol. The significant differences between the two groups remained after adjusting for body composition, alcohol intake, cigarette smoking and physical activity. There was a significant difference between the two groups in liver function as measured by the liver enzymes, SGOT, SGPT, with liver enzyme concentrations lower in the estrogen users. The results indicate that the increase in the total HDL cholesterol as a result of menopausal estrogen is primarily the result of increased HDL2. The increase could not be explained by alterations in hepatic microsomal activity as measured by liver enzymes since estrogen users had lower concentrations of liver enzymes than non-estrogen users.

Alcohol Drinking↗