From Sedation to Injury: Isoflurane‐Associated Hepatic Dysfunction: A Series of 3 Intriguing Cases

ABSTRACT Hepatitis occurring post‐induction of general anesthesia remains a perplexing conundrum of medicine. Isoflurane, one of the most commonly employed drugs in the maintenance of anesthesia worldwide, has succeeded outdated agents such as halothane. Despite its widespread and high frequency of usage, there exist unanticipated and undesirable side effects and toxicity that are usually overlooked, as the symptoms are mostly generic and insidious. It is reported that isoflurane causes acute liver injury ranging from mild transaminitis to fulminant hepatic failure. This case series discusses patients who have been unfortunate victims of this situation, developing severe transaminitis after exposure to isoflurane during general anesthesia induction and maintenance for surgical interventions for their respective ailments in the absence of any other relevant causal links. Every patient presented with postoperative jaundice and markedly elevated liver enzymes, which were treated conservatively, resulting in full recovery. In the absence of more specific therapies, conservative management remains the cornerstone of treatment. In this article, 3 intriguing cases have been described. These cases highlight the need for more research and greater awareness of isoflurane‐induced hepatotoxicity, especially given its non‐specific presentation.