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Acta Medica Medianae
Vol. 49, No 3, September, 2010

UDK 61
ISSN 0365-4478(Printed version)
ISSN 1821-2794(Online)


Correspondence to:

Angelina Bogićević

Department of anaesthesia and reanimation

Surgery Clinic; Clinical Center Niš

Bulevar Dr Zorana Đinđića 48, 18 000 Niš

E-mail: angelina.bogicevic@gmail.com






Case report
UDC:  616-008.9:616-089.5


Anesthetic management for a patient with acute intermittent porphyria



 Angelina Bogićević, Lidija Đorđević, Biljana Stošić, Dragana Đorđević, Nenad Savić and Anica Pavlović



                        Department of Anesthesia and Intensive Care, Surgery Clinic, Clinical Center Niš, Serbia 1

                        Department for Endocrine Surgery, Surgery Clinic, Clinical Center Niš, Serbia2



Acute intermittent porphyria is a rare metabolic disorder resulting from a partial deficiency of porphobilinogen  deaminase, enzyme in the heme biosynthetic pathway. Its inheritance is autosomal dominant. A deficiency of porphobilinogen deaminase is not sufficient by its self to produce acute intermittent porphyria, and other activating factors must also be present. These include some drugs, hormones, infection, injury and alcohol.

Besides others, anesthetics have been implicated in the triggering of a number of severe porphyric reactions. Although there is no clinical evidence, the fear of hypothesized porphyrinogenicity of repetitive anesthetics exposures still remains. Despite these doubts, we report here the case of uneventful repeated exposure to anesthetics in a patient suffering from acute intermittent porphyria, within a fifteen- month period. On both occasions, the patient was safely exposed to certain anesthetics included: propofol, sevoflurane, rocuronium, midazolam and fentanyl. Acta Medica Medianae 2010;49(3):55-57.


Key words: porphyria, anesthetics, complications