thiopental and Porphyrias

Topics: Anesthesia, General; Anesthetics; Humans; Porphyrias; Thiopental

Topics: Anemia, Sickle Cell; Anesthetics; Animals; Barbiturates; Cholinesterases; Fever; Genetics, Medical; Humans; Huntington Disease; Hyperkalemia; Metabolism, Inborn Errors; Muscular Dystrophies; Myotonia Congenita; Pharmacogenetics; Porphyrias; Succinylcholine; Swine; Thiopental

Topics: Diagnostic Errors; Electroconvulsive Therapy; Female; Humans; Hypnotics and Sedatives; Middle Aged; Porphyrias; Schizophrenia; Thiopental; Treatment Outcome

To evaluate the risk of inducing acute symptoms after general anesthesia in patients with "inducible " porphyrias, the authors analyzed retrospectively the effects of 78 exposure to anesthesia in 47 patients, 33 with acute intermittent porphyria and 14 with variegate porphyria. On 62 occasions, 29 involving the use of a barbiturate, anesthesia was induced in 37 patients who had no porphyric symptoms at the time. None of these patients had an acute attack postoperatively. Anesthesia was induced 16 times in 14 patients during acute episodes; 12 of these patients also received precipitating drugs other than anesthetics. Porphyric symptoms worsened in seven in the ten patients who received thiopental and in two of the four who did not. In the latent stages of acute intermittent and variegate porphyria in this patient population, the risk of incurring symptoms after exposure to thiopental and/or other anesthetics was small. During an acute episode thiopental may aggravate porphyric symptoms.

Topics: Acute Disease; Adolescent; Adult; Aged; Anesthesia, General; Barbiturates; Ether; Female; Halothane; Humans; Male; Nitrous Oxide; Porphyrias; Postoperative Complications; Succinylcholine; Thiopental; Time Factors; Tubocurarine

Topics: Adult; Chloramphenicol; Female; Humans; Male; Middle Aged; Porphyrias; Thiopental

Topics: Acute Disease; Adult; Anesthesia, Intravenous; Female; Humans; Porphobilinogen; Porphyrias; Thiopental

A simplified classification of the porphyrias is given which is thought to be advantageous to the anesthesiologist in determining those patients who are predisposed to acute attacks. These acute attacks may be precipitated by the administration of barbiturates, but may also be spontaneous. The current theory for the precipitation of the acute attack is described, with the probable mechanism being a decrease in uroporphyrinogen synthetase levels and the resultant interference in heme production. Increased formation of cytochrome P-450 with barbiturates also produces increased levels of delta aminolevulinic acid, which may be a cause of the acute attack. The significance in anesthesia and suggested means of anesthetic management are discussed.

Topics: 5-Aminolevulinate Synthetase; Acute Disease; Aminolevulinic Acid; Ammonia-Lyases; Anesthesia; Anesthetics; Child; Chlordiazepoxide; Cytochrome P-450 Enzyme System; Demyelinating Diseases; Diazepam; Heme; Humans; Neostigmine; Pentazocine; Porphobilinogen; Porphyrias; Thiopental

Topics: Anesthesia; Anesthesia, Inhalation; Anesthetics; Appendectomy; Appendicitis; Drug Therapy; Halothane; Humans; Metabolism; Porphyria, Acute Intermittent; Porphyrias; Porphyrins; Succinylcholine; Thiopental

Topics: Anesthesia; Barbiturates; Humans; Phenobarbital; Porphyrias; Thiopental; Toxicology