Renal and Hepatic Injury Associated with Methoxyflurane Anesthesia

Abstract

Methoxyflurane (Penthrane®) is a halogenated ether with a structure resembling that of halothane. Anesthesia with methoxyflurane is occasionally followed by hepatic injury similar to that after exposure to halothane. In addition, methoxyflurane anesthesia may be complicated by a distinctive syndrome of renal tubular injury characterized by inability to concentrate urine, dehydration, and azotemia, which may persist in part for several months. The first reported instance of both conditions occurring in the same patient is described, and the causes and implications of the hepatic and renal lesions are discussed. Methoxyflurane-induced hepatic injury is probably a hypersensitivity reaction, and methoxyflurane should accordingly not be used for patients who have reacted adversely to either methoxyflurane or halothane on previous occasions. Neither or these compounds should be readministered to patients who have been exposed to them before, even if such use has been without incident, when other anesthetic agents can be substituted. The renal lesion may result in part from a direct toxic action of methoxyflurane on the renal tubule. Little is known, however, of its causes and incidence, and further study of this complication is indicated.