A patient with Child-Pugh class B cirrhosis requires cholecystectomy. Which inhalational agent is safest for maintenance of anaesthesia given hepatic considerations?

• A Halothane
• B Enflurane
• C Desflurane at >8% inspired concentration
• D Sevoflurane ✓

Explanation

Sevoflurane undergoes minimal hepatic metabolism (~5%) and does not generate trifluoroacetyl halide intermediates that mediate immune-mediated hepatitis. Halothane (20% hepatic metabolism) is contraindicated due to risk of halothane hepatitis, which is particularly dangerous in an already compromised liver. Enflurane (2.5% metabolism) also produces trifluoroacetyl metabolites. High-concentration desflurane causes sympathetic activation that further reduces hepatic blood flow. Sevoflurane best preserves hepatic perfusion among modern agents.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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