Morphologic Changes in Hepatic Necrosis Following Halothane Anesthesia in Man

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Abstract
Clinical histories of 18 patients who developed hepatic necrosis after halothane anesthesia were examined. A definite trend as to the patients'' age, sex, ethnic origin, operation, coincidental therapy with potentially hepatotoxic drugs, or common operative or anesthetic complication which might predispose to hepatic necrosis was not apparent. The usual symptoms and signs were nausea, vomiting, chills, fever, jaundice and lethargy. Common laboratory findings included elevated serum transaminases, bilirubin and alkaline phosphatase. Pathological specimens from 13 patients were studied. The degree of hepatic necrosis varied from mild centrolobular acidophilic degeneration and fatty change to massive central, midzonal or complete lobular coagulation necrosis with coarse cytoplasmic vacuolization, fatty change and ghost cell formation. Only a minimal degree of inflammatory change was present. It was concluded that viral infection was probably not the underlying etiology and halothane may have acted as a hepatotoxin. The possibility of hyper-allergic reaction in this rare and unpredictable complication of halothane anesthesia cannot be excluded.

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