Acetaminophen-induced, Not Desflurane-induced, Hepatotoxicity

摘要

I believe that the case of hepatotoxicity after desfluraneanesthesia in a 15-month-old child with Mobius syndrome after previous exposure to isoflurane, reported by Drs. Cote and Bouchard, is not a case of desflurane-induced but acetaminophen-induced hepatotoxicity. Drs. Cote and Bouchard ignored that liver enzyme levels were too high for desflurane-induced hepatotoxicity, that the serum level of acetaminophen on the second postoperative day after multiple doses was high enough to induce hepatotoxicity, and that omeprazole is an inducer of the cytochrome P-450 enzymes (CYPs) CYP 1A2 and CYP 3A4, which increase oxidative metabolism of acetaminophen. They also ignored that cisapride increases the bioavailability of acetaminophen by inhibiting its glucuronidation in humans.