Halothane Hepatotoxicity Treatment & Management

Updated: Oct 17, 2016
  • Author: Ruben Peralta, MD, FACS; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, MCCM  more...
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Treatment

Medical Care

No specific therapy is available for either fulminant hepatic necrosis or mild hepatotoxicity due to halothane. Only supportive therapy and orthotopic liver transplantation are available for hepatic necrosis.

Because halothane hepatitis is a diagnosis of exclusion, ruling out other causes is essential.

As in any form of fulminant hepatitis, take the following measures when instituting supportive therapy:

  • Maintain fluid and electrolyte balance.
  • Support hemodynamics as necessary.
  • Support ventilation as necessary.
  • Correct any alterations in coagulation.
  • Correct hypoglycemia.
  • Treat any other complications of the comatose state.
  • Restrict protein intake and administer oral lactulose or neomycin.

High-dose corticosteroid therapy has been used in liver failure but has been shown ineffective in controlled trials.

Molecular adsorbent recirculating system (MARS) is a safe temporary life support mechanism for patients awaiting liver transplantation or recovering from fulminant hepatic failure.

An animal study concluded that zinc has the potential to alleviate halothane-toxic effects in the liver of rats by demonstrating a reduction of hepatic enzyme levels and reduction in liver damage in the zinc-halothane group. Further translational studies are warranted. [7]

Because clinical deterioration may be rapid and because of the high risk of mortality, patients may require monitoring in an intensive care unit.

Hospitalized patients may be discharged when the following criteria are met:

  • Significant improvement in symptoms
  • Normalization of prothrombin time
  • A substantial downward trend in the serum aminotransferase and bilirubin values occurs. Mildly elevated aminotransferase levels should not be considered contraindications to the gradual resumption of normal activity as tolerated.
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Surgical Care

If fulminant liver failure occurs and liver function does not recover, orthotopic liver transplantation has been a successful option and may be considered.

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Consultations

Consult with a hepatologist for assistance in confirming the diagnosis.

Consult with a critical care specialist for support of metabolic, respiratory, and cardiovascular issues.

Consult with organ procurement team and transplant teams, including transplant surgeon, if liver failure is imminent.

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Diet

Restrict protein intake and administer oral lactulose or neomycin.

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Activity

Although bed rest is not essential for full recovery, many patients feel better with restricted physical activity.

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Prevention

The most conservative approach is to avoid halothane when reasonable alternatives exist. For example, because of the medicolegal climate in the United States, halothane is infrequently used in adults since several alternatives exist and any postanesthetic liver dysfunction is likely to be ascribed to halothane. In many other countries with different medicolegal climates, halothane is still widely used because of economic reasons.

The anesthesia profession is becoming more aware of the occupational exposure and adverse environmental impact of inhalational anesthetics, which includes ozone damage and greenhouse gas effect. A call for the modification in anesthetics procedures and the role of total intravenous anesthesia in selected procedures is being advocated by some. [8]

Carefully consider halothane use in any adult patient with recent exposure in the past 6 weeks. Recent exposure is the most important risk factor for type II fulminant hepatotoxicity.

In patients with a history of jaundice and fever following previous halothane exposure, all volatile anesthetics (ie, halothane, enflurane, isoflurane, sevoflurane, desflurane) should be used with caution and indications should be documented.

Patients with unexplained elevations of liver functions should not undergo anesthesia and elective surgery until a diagnosis has been confirmed. Any type of surgery and anesthesia in the setting of acute hepatitis carries the potential for increased mortality and morbidity.

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