Hepatotoxicity after desflurane anesthesia in a 15-month-old child with Mobius syndrome after previous exposure to isoflurane.

HALOGENATED anesthetic agents have been associated with perioperative liver dysfunction and injury. Most cases of hepatotoxicity reported involve halothane exposure. Halothane produces two types of hepatotoxicity. A mild, transient syndrome with modest increases in transaminase enzymes occurs in 20% of patients given halothane. A more severe and fulminant hepatitis with marked liver dysfunction, jaundice, encephalopathy, and even death is observed in 1 in 20,000 anesthetic exposures to halothane. Halothane toxicity occurs in children as well as in adults. Cross-sensitization between halothane and other volatile agents has been previously reported with isoflurane, enflurane, and desflurane. To date, only four cases of hepatotoxicity in adults were related to desflurane exposure. We report the case of a young child who developed acute hepatotoxicity after desflurane anesthesia in the context of two previous isoflurane exposures.