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題名 | Reproducible Hepatic Dysfunction Following Separate Anesthesia with Sevoflurane and Desflurane=Sevoflurane及Desflurane引致可逆性肝功能異常 |
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作者 | 鍾志豪; 邱世欽; 連昭明; 李漢倫; 黃仲衡; | 書刊名 | 長庚醫學 |
卷期 | 26:5 2003.05[民92.05] |
頁次 | 頁357-362 |
分類號 | 416.5 |
關鍵詞 | 肝功能; 過敏; Isoflurane; Sevoflurane; Desflurane; Liver function; Hypersensitivity; |
語文 | 英文(English) |
中文摘要 | 雖然desflurane和sevoflurane曾分別被報告引致肝功能異常,但發生在同一人則未曾被報告過。由於desflurane和sevoflurane的代謝產物本質上不同,兩者間似乎並不會產生敏感,而引致肝功能異常。本文首次報告一病患在接受sevoflurane及desflurane後表現可逆性肝功能異常。此一54歲的男性病患連續接受三次麻醉,第一次以isoflurane的麻醉過程平順。第二次以sevoflurane麻醉後17天後卻產生發燒、顫抖及Aspartate aminotransferase(534 []/L)上升。在第三次以desflurane麻醉後17天亦產生相似的臨床徵狀。症狀及血中轉胺?在保守治療下完全恢復。由於相似的發病時間,及排除其他可能性原因下,我們高度懷疑此肝功能異常乃由sevoflurane及desflurane所引致。吾人建議於此診斷下,在後續手術中應改用完全靜脈麻醉藥,以取代吸入性麻醉藥。 |
英文摘要 | Both desflurane and sevoflurane have individually been reported to induce hepatic dysfunction; however hepatic dysfunction after administration of both of them separately in a single patient has not previously been reported. As their metabolites differ in nature, we considered that it would be unlikely that their combined use would cause sensitization and induce hepatic dysfunction. We report on the first patient with reproducible liver dysfunction after sevoflurane and desflurane. This 54-year-old man sequentially received 3 anesthetics over a 1-year period. The first anesthetic was isoflurane, and the course was uneventful. The second anesthetic was sevoflurane, and this resulted in fever with chills and elevated aspartate aminotransferase (543 U/I) 17 days later. The third anesthetic was desflurane which resulted in a similar clinical picture after 17 days. The symptoms improved, and the serum transaminase level returned to normal after conservative therapy. The similar time interval between the operation date and the onset of hepatic dysfunction, after excluding other possibilities, made us highly suspicious that the hepatic dysfunction was induced by sevoflurane on 1 occasion and desflurane on the other. We suggest that inhaled anesthetics should be totally replaced by intravenous anesthetics for future operations in patients with such a diagnosis. |
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