General Anesthesia in “Inducible” Porphyrias

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Abstract
To evaluate the risk of inducing acute symptoms after general anesthesia in patients with inducible porphyrias the effects of 78 exposures to anesthesia in 47 patients, 33 with acute intermittent porphyria and 14 with variegate porphyria were studied. 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 the patients had an acute attack postoperatively. Anesthesia was induced 16 times in patients during acute episodes; 12 of these patients received precipitating drugs other than anesthetics. Porphyric symptoms worsened in 7 in the 10 patients who received thiopental and in 2 of the 4 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.