Hepatic necrosis associated with halothane anesthesia

Abstract Fatal hepatic necrosis following halothane anesthesia occurs in rare instances and is associated with a recognizable clinical pattern and characteristic, but not pathognomonic, morphologic changes. Described herein are three stages of hepatic damage that are related to the duration of symptoms. Fatal hepatic necrosis following other surgical anesthetics was not observed in a review of the records of 81,535 routine autopsies at LAC-USC Medical Center. Unexplained postoperative fever was one of the most constant features indicative of liver damage. Our data indicate that the frequency of fatal hepatic necrosis is increased in obese subjects who had previously received halothane two or more times within a one month period. The histologic data suggest that necrosis of the liver is not a simple sensitization to halothane but that the initial exposure may produce idiosyncratic necrosis of insufficient extent to produce recognizable signs. In contrast to viral hepatitis, hepatic damage sufficient to cause death of the patient usually involves the liver stroma. As a result, patients who survive more than two or three weeks tend to have collagen deposition that differs from that observed in the liver of patients with fulminant viral hepatitis.