Acute liver injury following re-exposure to sevoflurane after a 12-year interval

Background: Sevoflurane is a commonly used halogenated inhalational anesthetic with a relatively low risk of hepatic toxicity compared to other agents. Unlike other halogenated anesthetics, sevoflurane undergoes minimal metabolism into reactive intermediates that could induce hepatotoxicity. However, rare cases of acute liver injury following re-exposure have been reported. Case: We present a case of a 70-year-old woman who underwent elective clipping of a left middle cerebral artery aneurysm under general anesthesia with sevoflurane. She had previously received sevoflurane, 12 years earlier, without complications. Liver function tests performed two hours after surgery showed a significant elevation in liver enzymes. A thorough evaluation, including virological, autoimmune and drug-induced liver injury assessments, yielded no alternative cause. An urgent multidisciplinary consultation was conducted, and a diagnosis of sevoflurane-induced liver injury was considered after excluding other potential causes. The patient was then promptly treated with hepatoprotective agents and had, rapid enzyme normalization. After full recovery without further complications, she was discharged. Conclusions: Although sevoflurane is considered to have minimal hepatic toxicity, this case highlights the potential risk of liver injury upon re-exposure. Vigilant liver function monitoring in patients with prior exposure to halogenated anesthetics is essential, particularly when re-administering sevoflurane. Early recognition and timely intervention may prevent severe complications.

Sevoflurane; Hepatotoxicity; Liver injury; Anesthesia; Halogenated anesthetics; Acute liver dysfunction

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