Current Status of Hepatotoxicity of the Halogenated Inhalation Anesthetics

Abstract

The introduction of halothane to the clinical practice of anaesthesia was a milestone in its development. Here was an anaesthetic which was easily controllable, potent, pleasant for the patient, and with a minimum of deleterious side effects. Although there were individuals who voiced the opinion that the drug might have some of the potential hepatotoxic drawbacks of chloroform, Raventos’ [1] early observations indicated that no direct liver toxicity was seen following anaesthesia with halothane in experimental animals. However, within a number of years following the release of halothane, there was a plethora of articles reporting unexplained and unanticipated jaundice and massive hepatic necrosis following anaesthesia with this drug [2, 3,4]. These cases created considerable controversy, primarily more heat than light. The cases of jaundice were rare and sporadic. However, sufficient numbers were reached to spur the National Halothane Study [5], one of the largest epidemiologic works ever performed. U fortunately, this study was inconclusive. There appeared to be a non-statistically significant hint of a problem involving halothane, but it was certainly not proven by this large nonrandomized and retrospective epidemiologic study.