HYPOXIC HEPATITIS AFTER IN-HOSPITAL CARDIAC ARREST - A CASE REPORT

Hypoxic hepatitis (HH) is a condition of insufficient hepatic blood flow, due to shock or hypotension. It is characterized by an elevation of aminotransferases over 20times the upper limit of normal during first 72hrs after return of spontaneous circulation (ROSC). Most of the cases reported are out-of hospital cardiac arrest(OHCA) with poor neurological outcomes. We are reporting a case of HH following ROSC, in hospital witnessed cardiac arrest (IHCA) with full neurological recovery. A 61year old female was scheduled for excision of meningioma between D1-D3 vertebrae under general anaesthesia. Induction and maintenance of anaesthesia was done as per routine protocol. Throughout the surgery, haemodynamics were maintained stable. But while transfusing 2^nd unit of blood, patient developed sudden episode of hypotension(Blood Pressure-70/36mmHg) and bradycardia followed by asystole. Cardio-pulmonary resuscitation(CPR) was started in prone position immediately. On removing the drapes, red wheal rashes were observed all over the back. The ongoing blood transfusion was stopped. The patient was made supine and CPR was continued as per ACLS protocol for 45minutes after which ROSC was achieved. Patient was then shifted to Intensive Care Unit(ICU) for post-resuscitation care. During the recovery phase in ICU, significant increase in transaminases(more than 20folds) were observed in first 24hours, which got normalized over 5days along with full neurological recovery of the patient. HH is not a complication which we as an anaesthesiologists usually encounter but its not a rare one. Our case highlights that HH is potentially reversible and may not always be associated with poor neurological outcome.