Propofol or sevoflurane anaesthesia does not affect hepatic integrity as assessed by the M30 & M65 cell death markers & liver enzymes.

General anaesthetics though considered safe, on rare occasions have been incriminated for severe liver damage and patient's fatal outcome1,2,3,4. Propofol has been shown to exert an apoptotic effect on the human promylocytic leukemia cells (HL-60 cells), which are sensitive to proapoptotic stress, as the drug interferes with both the mitochondrial and cell surface pathways1. In the clinical setting, cases of hepatotoxicity after exposure to propofol anaesthesia for short duration surgery have been reported, with high transaminase levels and liver histology indicating hepatocellular injury2. Sevoflurane has also been shown to cause hepatotoxicity. Hepatic necrosis occurred in a 37 yr old man after sevoflurane anaesthesia4. Fulminant hepatic necrosis with fatal outcome occurred in another patient exposed to sevoflurane for repair of a torn subclavian vein during central venous catheter insertion4. The M30 (caspase-cleaved cytokeratin-18) is a monoclonal antibody, which recognizes a neoepitope generated from caspase cleaved keratin-18 at the Asp396 site, and serves as a biomarker of epithelial apoptosis in the liver. The M65 (intact cytokeratin-18) is a substrate expressed by epithelial cells like hepatocytes suggesting necrosis6. The circulating levels of the M30 and M65 have been used to assess severe liver impairment in pathological conditions like fibrosis in heavy alcohol drinkers7, to identify patients suffering from α1- antitrypsin deficiency later developing liver disease8, and as predictive markers in acute liver failure due to acetaminophen toxic doses9. The aim of this study was to identify possible changes in the apoptotic and/or necrotic markers M30 and M65 and in the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) enzymes, in female patients undergoing elective mastectomy or thyroidectomy under propofol or sevoflurane anaesthesia.