Canadian Journal of Anesthesia, Vol 12, 443-449, Copyright © 1965 by Canadian Anesthesiologists' Society

Hepatic Circulation and Hepatic Function During Anaesthesia and Surgery III Chloroform-Induced Liver Injury

¹ Department of Neurology and Neurosurgay, McGill University and the Montreal Neurological Institute and Hospital, and the Department of Surgery, the Royal Victoria Hospital

There are several causes of reduced oxygen supply to the liver during a surgical operation Arterial hypotension, metabolic acidosis, trauma to the liver, and anaesthesia, alone or combined, all depress hepatic blood–flow and portal oxygen tension. Under some circumstances this depression extends into the post–surgical period when other factors, yet unknown, may be added to prolong hypoxia of the liver A normal liver can escape injury or is able to regenerate However, previous liver disease, sub–clinical viral hepatitis⁶ may contribute, in a hypoxic liver, to the, to the developement of a severe injury Therefore, post–surgical hepatic necrosis must be recorded as a syndrome in which anaesthesia is one factor This could explain the difficulties reported in clinical studies which try to correlate anaesthesia with liver damage ^7–10 On the other hand, some anaesthetic agents such as chloroform contribute more than others to hepatic hypoxia, quite apart from thier possible direct toxicity Since it is impossible to prevent some physiological disturbances during surgery, it seems safer not to use such an agent As for other anaesthetics, this study is being repeated with each one of them in order to establish the circum–stances in which they may contribute to post–surgical hepatic demage.

Hyperbaric oxygen during surgery may be considered of therapeutic value in patients with marked liver dysfunction Finally, it seems clear that in the develop–ment of hepatic damage, the immediate recovery perid is as the surgical intervention itself.