Fatal Hepatic Necrosis Following Surgery

METHOXYFLURANE(Penthrane), a halogenated ether partially resembling halothane (Fluothane) in structure (see structural formula), has been used in general anesthesia since its introduction in 1959.1Although the structure of halothane was modified by the substitution of a methoxy-group for a fluorine atom, the basic structures are similar and it would not be surprising if the biologic effect produced by each were also similar. There have been several reports of suspected hepatotoxicity secondary to halothane2-6while there are only three reports in the HALOTHANE METHOXYFLURANE English literature of severe liver damage secondary to methoxyflurane anesthesia.2,7,8We recently had a patient on the Medical Service at Grady Memorial Hospital who developed fulminant liver failure with onset of symptoms approximately 14 days after orthopedic surgery in which methoxyflurane was the primary anesthetic agent. We offer this as a suspected example of massive hepatic necrosis related to the use of this halogenated