Halothane hepatitis in a South African population--frequency and the influence of gender and ethnicity

Abstract

Aim: To review post-anaesthetic hepatitis in a South African population, given that halothane use is restricted in other countries because of the high mortality and morbidity of its associated type II (idiosyncratic) hepatitis, even though it is still widely used in South Africa.

Study design: Descriptive, retrospective analysis.

Patients and methods: Hepatitis cases that occurred after inhalational anaesthetic use were identified by means of a computer search of Groote Schuur Hospital records, 1980-1994. Cases of hepatitis caused by circulatory failure and viral hepatitis were excluded.

Results: Twenty-six episodes occurred in 22 patients (mean age 49.05 years, range 32-65 years), of whom 15 were women. This gave an estimated incidence of 3.53/100,000 anaesthetics (95% confidence interval 2.06-5.0/100,000). All had pyrexia (mean 38.7 +/- 0.72 degrees C), malaise, anorexia or nausea and vomiting, with onset a mean of 4.27 +/- 3.5 days after exposure. Jaundice occurred in 86%, rash in 13.6%; 17 patients (77%) were obese. Alanine and aspartate aminotransferase levels were raised 47.49 +/- 61.8 and 55.9 +/- 54.5 times the upper limit of normal. Seven patients died and 1 underwent liver transplantation. Hepatitis occurred after the first exposure in only 2 patients (9%). Men and women had a similar risk, but the estimated relative risk for whites v. black or coloured patients was 3.33 (95% confidence interval 1.45-7.23; P = 0.003) controlling for gender. Awareness of the condition was suboptimal, and in 3 patients re-exposure to halothane occurred after an initial episode of typical halothane hepatitis.

Conclusion: Halothane hepatitis remains a major cause of morbidity and mortality in South Africa. It is more common in whites, but there was no gender-related excess risk.