General Anaesthesia in the Acute Porphyrias
General anaesthesia may be safely
undertaken in patients with an acute porphyria
(Acute Intermittent Porphyria, Variegate Porphyria
or Hereditary Coproporphyria) providing care
is taken to select anaesthetic agents that are
known to be safe.
In those patients in whom it is necessary to
proceed with anaesthesia before a definitive
diagnosis is made it is best to treat the patient
as if they were affected (Link to diagnostic
page).
The patients at most risk from a general anaesthetic
are those whose porphyria is, or has been recently
active.
No drug should be withheld from a porphyria
patient facing a serious or life threatening
emergency and conversely inclusion of a drug
does not guarantee that it will be safe in all
circumstances.
General measures
Patients should include avoid a prolonged
fast both preoperatively and postoperatively.
Stress should be minimised by effective pre-medication
and postoperative analgesia.
Post operative complications especially infection
should be treated aggressively (see Antibiotic
treatment guidelines)
Drugs used During Anaesthesia
The table below has been compiled from information
in the literature and is intended for guidance
only.
Some drugs cannot be classified due to lack
of information or because there is conflicting
information in the literature.
Inclusion of a drug does not guarantee that
it will be safe in all circumstances.
For more detailed information
the review by James and Hift (Br J. Anaes. Vol
85(1): 143-53) may be helpful.
| |
Safe |
Probably
or possibly safe |
Unsafe
or no data |
| Induction |
Propofol
|
Ketamine
Midazolam |
Thiopental
Etomidate |
| Inhalational |
Nitrous oxide
Enflurane
|
Isoflurane
Sevoflurane
|
Fluroxene
methoxyflurane |
| Paralysis |
Suxamethonium
Muscle relaxants non-depolarising
Vercuronium
Atracurium
Mivacurium
Cisatracurium
|
Alcuronium
|
|
| Analgesia |
Fentanyl
Opiates (morphine diamorphine, pethidine)
|
Oxycodone
Nalbuphine
|
Pentazocine |
| Sedatives/Antiemetics |
Phenothiazines
Domperidone
Temazapam
Triazolam
|
|
Nitrazepam |
| Hypotension |
Adrenaline
Noradrenaline
|
|
|
| Other |
Atropine
Alpha agonists
Beta agonists
Beta blockers
Magnesium
Neostigmine
Phentolamine
|
Verapamil
Flumazenil
Naloxone
|
|
| 
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