Abstract
This report describes a patient who developed hepatic coma following methoxy-flurane anesthesia and recovered following exchange transfusion. The difficulties delineating the true hepatotoxin in this setting are discussed, but it is considered likely that methoxyflurane was responsible. A review of past experience with this agent and analogous halogenated hydrocarbon anesthetics strongly suggests an association with hepatic dysfunction. Until this relationship is disproven, we feel that this anesthetic should not be used as an agent of first choice in patients with a history of unexplained postoperative fever, rash or eosinophilia. The risk to operating-room personnel, who may have been inadvertently sensitized, must be considered.
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