A 72-year-old patient with hepatic cirrhosis (Child-Pugh C) is undergoing elective abdominal surgery. Which inhalational agent is MOST implicated in causing liver necrosis via reductive metabolism under hypoxic conditions?

• A Isoflurane
• B Sevoflurane
• C Desflurane
• D Halothane ✓

Explanation

Halothane undergoes approximately 20% hepatic metabolism; under hypoxic microenvironmental conditions, reductive metabolism generates trifluoroacetyl chloride and free radicals that cause centrilobular necrosis (halothane hepatitis type II). Isoflurane and desflurane are metabolised <0.2% and <0.02% respectively, making hepatotoxicity negligible. Sevoflurane's metabolism generates hexafluoroisopropanol but this is conjugated safely without hepatotoxic reductive intermediates.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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