Acute intermittent porphyria and caesarean delivery

A 29-yr-old patient was diagnosed with acute intermittent porphyria (AIP) during pregnancy. She had a Caesarean section under lidocaine/fentanyl epidural blockade. Because of inadequate analgesia, general anaesthesia was induced with propofol. Postoperatively urinary porphobilinogen excretion (625 mumol.day-1) exceeded the upper limit of normal but no symptoms of porphyria developed. In anecdotal clinical reports and in a previously described rat model of porphyria, propofol was found to be safe. This is the first reported use of propofol in a pregnant porphyric patient. Anaesthetic drug safety in porphyria is reviewed and the choice of induction agent discussed. Data on which to base these decisions is limited but we conclude that propofol may be suitable for use in patients with porphyria.