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[Desflurane in acute intermittent porphyria].
M Messmer1, F Gerheuser, H Forst
1Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg. messmer@anaesthesie-klinikum-augsburg.de
Der Anaesthesist
|March 17, 2004
Summary
This case study shows that desflurane anesthesia was safe for a patient with acute intermittent porphyria (AIP). Perioperative management successfully prevented a porphyric attack, suggesting desflurane as a viable anesthetic option for AIP patients.
Area of Science:
- Anesthesiology
- Pharmacology
- Genetics
Background:
- Acute intermittent porphyria (AIP) is a rare genetic disorder.
- Anesthetic management in AIP patients requires careful drug selection to avoid triggering attacks.
- Volatile anesthetics like halothane and isoflurane are considered safe, but data on desflurane is lacking.
Observation:
- A patient with AIP undergoing hemihepatectomy received a balanced anesthesia technique.
- The technique included desflurane, sufentanil, atracurium, and continuous epidural analgesia.
- Porphyrin precursor levels were monitored pre- and postoperatively.
Findings:
- Preoperative porphyrin precursor excretion was high, confirming AIP.
- Postoperative urinary porphyrin precursor levels decreased significantly, normalizing by day 5.
- No clinical symptoms of a porphyric attack occurred during hospitalization.
Implications:
- Desflurane may be a safe and effective anesthetic alternative for patients with AIP.
- Careful perioperative management can prevent acute porphyric attacks.
- Further research is warranted to confirm desflurane's safety profile in AIP.