Desflurane
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Hepatic failure: case report A 52-year-old man developed fulminant hepatic failure after general anaesthesia with desflurane. The man received desflurane [dosage and route not stated] during surgery for a distal radius fracture. Three days later, his wife noted oliguria and an altered mental status. On admission, he had fulminant hepatic failure with loss of synthetic liver function, cerebral oedema, and severe transaminitis. His Apache II score was 22 and he displayed asphasia with mild left-sided weakness. He was mechanically ventilated for a declining mental status and his clinical course was complicated by anuric renal failure, disseminated intravascular coagulation, and numerous, bilateral intraparenchymal haemorrhages. Biopsy showed coagulative necrosis consistent with toxic hepatic insult; however, he was considered a poor candidate for orthotopic liver transplantation due to his cognitive dysfunction and haemorrhages. The man’s cognitive condition fluctuated, while his hepatic function normalised with medical support. He was discharged to a rehabilitation facility, now with a flurane allergy. Idiosyncratic drug-induced hepatitis was diagnosed. Author comment: "A diagnosis of Idiosyncratic DrugInduced Hepatitis was made based on the chronology of our patient’s exposure to desflurane . . ." Northcutt N, et al. Black diamond antibodies: A skiing accident leading to fulminant hepatic failure. Journal of Hospital Medicine 7 (Suppl. 2): 277-278, Mar 2012. Available from: URL: http://dx.doi.org/10.1002/jhm.1927 [abstract] 803070169 USA
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Reactions 19 May 2012 No. 1402
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