chloroform to the highly reactive acid chloride phosgene (59)86-88 (eqn [20]). Similarly, the inhalation anesthetic halothane (60) is converted to trifluoroacetyl chloride (61) (eqn [21]), which in turn can covalently bind to protein, generating liver protein neo-antigens.89'90 In susceptible individuals these neo-antigens stimulate the production of anti-trifluoroacetyl-protein antibodies, which can cause fatal halothane hepatitis upon re-exposure to the anesthetic. The related anesthetics enflurane (62) and isoflurane (63) are also subject to acyl halide formation and an ensuing hepatic dysfunction similar to that caused by halothane.91-93


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