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Fernández-Candil J, Castelltort Mascó L, Fàbregas Julià N, Urretavizcaya Sarachaga M, Bernardo Arroyo M, Valero Castell R. Anaesthesia in electroconvulsive therapy. Special conditions. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 13:36-46. [PMID: 30078550 DOI: 10.1016/j.rpsm.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 05/20/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is one of the main techniques available for the treatment of such serious mental illnesses as schizophrenia and drug-resistant depression. The pre-anaesthetic assessment appropriate for patients with various mental disorders or pathologies does not differ substantially from that of any patient prior to undergoing anaesthesia for a surgical procedure. The present review aims to propose guidelines to achieve a higher level of safety and effectiveness during ECT in the most frequent situations, in accordance with the current literature. METHODS We conducted a search on the role of anaesthesia in ECT in the Ovid MEDLINE, PubMed, and SciELO (Scientific Electronic Library Online) databases, with special attention to the populations undergoing this type of therapy. The search was carried out between 1978 and December 2016. RESULTS We included the 96 articles that contained the most important recommendations for the preparation of this guide. CONCLUSIONS We propose these guidelines in order to achieve a higher level of safety and effectiveness during ECT in special conditions. We also summarize the most important attitude to be taken into account by the anaesthesiologist in these cases.
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Affiliation(s)
| | | | - Neus Fàbregas Julià
- Department of Anesthesiology, Hospital CLINIC de Barcelona, Barcelona, Spain
| | - Mikel Urretavizcaya Sarachaga
- Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL) Neurosciences Group-Psychiatry and Mental Health, L'Hospitalet de Llobregat, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Miquel Bernardo Arroyo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Department of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
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2
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Turton-Weeks S, Barone GW, Gurley BJ, Ketel BL, Lightfoot ML, Abul-Ezz SR, Anderson KE. Pretransplant Evaluation of a Patient with Acute Intermittent Porphyria. Prog Transplant 2016; 11:214-6. [PMID: 11949465 DOI: 10.1177/152692480101100311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The pretransplant evaluation of a patient with a rare diagnosis requires knowledge of the pathophysiology and the transplant literature. A 55-year-old man presented with hypertensive kidney failure and the clinical diagnosis of acute intermittent porphyria. Complications of acute intermittent porphyria, which is a defect of heme production, are due to the accumulation of heme intermediates often precipitated by medications. Based on animal data, cyclosporine is considered unsafe in patients with acute intermittent porphyria. As part of the pretransplant evaluation, the patient received separate trials of tacrolimus and cyclosporine, which did not stimulate his acute intermittent porphyria. Four months after a kidney transplant, the patient still had no signs of rejection or symptoms of acute intermittent porphyria. This is the first documented patient with acute intermittent porphyria who successfully received a kidney transplant using tacrolimus. Because of individual variations, pretransplant testing of calcineurin inhibitors should be continued in patients with acute intermittent porphyria.
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Affiliation(s)
- S Turton-Weeks
- University of Arkansas for Medical Sciences, Little Rock, Ark., USA
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3
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Bosch L, Villar T, Latorre MY, Pacreu S. Femoral and sciatic nerve block for knee arthroscopy in a patient with acute intermittent porphyria. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:423-426. [PMID: 27220836 DOI: 10.1016/j.redar.2016.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/11/2016] [Accepted: 03/16/2016] [Indexed: 06/05/2023]
Abstract
Acute intermittent porphyria is an autosomal dominant disorder that results from a partial deficiency of porphobilinogen deaminase and that causes very severe symptoms. Attacks may be triggered by a series of drugs and by other factors that the anesthesiologist should be aware of in order to reduce morbidity and mortality. Our objective is to review anesthetic considerations in acute intermittent porphyria. We present the case of a patient diagnosed with acute intermittent porphyria who was scheduled for knee arthroscopy. The anesthetic technique used was a femoral and sciatic nerve block under sedation with an infusion of remifentanil. The surgery proceeded without incident and the patient was discharged home after 24h. We consider the use of a peripheral plexus block of the lower limb to have been the safest anesthetic technique for this patient.
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Affiliation(s)
- L Bosch
- Department of Anaesthesiology and Reanimation and Therapy of Pain Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - T Villar
- Department of Anaesthesiology and Reanimation and Therapy of Pain Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Y Latorre
- Department of Anaesthesiology and Reanimation and Therapy of Pain Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Pacreu
- Department of Anaesthesiology and Reanimation and Therapy of Pain Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
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4
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Naithani BK, Shah SB, Bhargava AK, Batra V. Anesthesia for hemicolectomy in a known porphyric with cecal malignancy. Saudi J Anaesth 2015; 9:82-5. [PMID: 25558204 PMCID: PMC4279355 DOI: 10.4103/1658-354x.146320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Intraoperative management of a known acute intermittent porphyria patient is a challenge requiring awareness of factors, which trigger an acute crisis, clinical features of a porphyric attack, knowledge of safe pharmacologic intervention, and preparedness for reintubation and ventilatory support. The classical signs of a porphyric crisis such as pain abdomen, vomiting and neuropsychiatric symptoms are masked under general anesthesia and can be confused with postoperative pain and vomiting and postoperative cognitive dysfunction, especially for intra-abdominal surgeries. Eternal vigilance for onset of an acute crisis is imperative. After a crisis of acute intermittent porphyria, residual paresis may persist for years in the absence of further attacks.
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Affiliation(s)
- B K Naithani
- Department of Anesthesia, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Shagun Bhatia Shah
- Department of Anesthesia, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - A K Bhargava
- Department of Anesthesia, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Vivek Batra
- Department of Anesthesia, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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5
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Anesthetic management of vaginal tear repair during early puerperium in a patient with acute intermittent porphyria. EGYPTIAN JOURNAL OF ANAESTHESIA 2014. [DOI: 10.1016/j.egja.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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6
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Gene-environmental interactions: Lessons from porphyria. Environ Health Prev Med 2012; 7:254-63. [PMID: 21432394 DOI: 10.1007/bf02908884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2002] [Accepted: 08/22/2002] [Indexed: 10/22/2022] Open
Abstract
The porphyrias are uncommon, complex, and fascinating metabolic conditions, caused by deficiencies in the activities of the enzymes of the heme biosynthetic pathway. Two cardinal symptoms of the porphyrias are cutaneous photosensitivity and neurologic disturbances. Molecular analysis of gene defects has shown that there are multiple and heterogeneous mutations in each porphyria. Patients with symptomatic porphyria can suffer greatly, and, in rare cases, may die. While congenital porphyrias are inherited, other forms of porphyria occur as acquired diseases. In addition, not all gene carriers of inherited porphyrias develop clinical disease and there is a significant interplay between the gene defect and acquired or environmental factors. The variable response of porphyrias to acquired factors may, likely reflect genetic polymorphisms in drug metabolism. The lessons from acute hepatic porphyria, such as acute intermittent porphyria, are very useful in clarifying the complex nature of the clinical expression of metabolic disorders.
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7
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Armen TA, Sai-Sudhakar CB, Blais D, Awad H. Anesthetic Management for Combined Double-Valve and Coronary Artery Bypass in a Patient With Acute Intermittent Porphyria. J Cardiothorac Vasc Anesth 2009; 23:364-8. [DOI: 10.1053/j.jvca.2008.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Indexed: 11/11/2022]
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8
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Consolo D, Ouardirhi Y, Wessels C, Girard C. [Obstetrical anaesthesia and porphyrias]. ACTA ACUST UNITED AC 2005; 24:428-31. [PMID: 15826795 DOI: 10.1016/j.annfar.2005.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 01/12/2005] [Indexed: 11/20/2022]
Abstract
Acute hepatic porphyrias are genetic diseases, characterized by acute neurological symptoms, sometimes fatal, triggered by different factors, in particular by many anaesthetic drugs, and also by pregnancy. We report here the experience of three porphyric patients'deliveries, allowing us to consider a proposition of management in this context. After discussion between anaesthesiologist, obstetrician and porphyria specialist, two types of management of such patients can be foresee. Asymptomatic patients, or in long remission, can benefit from locoregional anesthesia techniques with bupivacaine for both labour analgesia and Caesarean section. Spinal anaesthesia is then the technique of choice, allowing using smaller quantity of local anaesthetic than epidural anaesthesia. For symptomatic patients, or in crisis, we have rather choose intravenous narcotics for labour analgesia, and general anaesthesia for Caesarean section. The hypnotic agent of choice for both induction and maintenance of such anaesthesia is then propofol.
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Affiliation(s)
- D Consolo
- Département d'anesthésie-réanimation, CHU le Bocage, 2, boulevard Maréchal-de-Lattre-de-Tassigny, 21000 Dijon, France.
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9
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Stojeba N, Meyer C, Jeanpierre C, Perrot F, Hirth C, Pottecher T, Deybach JC. Recovery from a variegate porphyria by a liver transplantation. Liver Transpl 2004; 10:935-8. [PMID: 15237381 DOI: 10.1002/lt.20136] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The porphyrias are a group of inherited or acquired enzymatic defects of heme biosynthesis. Each type of porphyria has a characteristic pattern of overproduction and accumulation of heme precursors based on the location of dysfunctional enzyme in the heme synthetic pathway. Variegate porphyria, one of the acute hepatic porphyrias, is characterized by a partial reduction in protoporphyrinogen oxidase, the seventh enzyme of the heme biosynthetic pathway. A case of liver transplantation is described with a recovery from a variegate porphyria. Acute porphyria is commonly worsened by a wide variety of medications. We describe a step-by-step perioperative management protocol.
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Affiliation(s)
- Nathalie Stojeba
- Department of Anesthesiology, Hôpital de Hautepierre, Strasbourg, France.
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10
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Bayón JE, Pascolo L, Gonzalo-Orden JM, Altonaga JR, González-Gallego J, Webster C, Haigh WG, Stelzner M, Pekow C, Tiribelli C, Ostrow JD. Pitfalls in preparation of (3)H-unconjugated bilirubin by biosynthetic labeling from precursor (3)H-5-aminolevulinic acid in the dog. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 2001; 138:313-21. [PMID: 11709655 DOI: 10.1067/mlc.2001.118746] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report problems encountered during preparation of tritium-labeled unconjugated bilirubin ((3)H-UCB) from precursor (3)H-5-aminolevulinic acid ((3)H-ALA) in 2 dogs with external biliary drainage installed into the animals under general anesthesia. Under prolonged sedation, 12.9 or 14.0 mCi of (3)H-ALA was administered intravenously in two divided doses, and bile was collected for 9 hours. In one animal, taurocholate (TC) infusion was needed to maintain bile flow. (3)H-UCB was isolated from the bile and recrystallized with the improved method of Webster et al (Webster CC, Tiribelli C, Ostrow JD. J Lab Clin Med 2001;137:370-3). Based on radioactivity and pigment content, hourly bile collections were pooled to optimize specific activities. Surprisingly, in the first dog, only 2.9% of injected radioactivity was recovered in bile and only 14.1% in urine, and the specific activities of the crystalline (3)H-UCB from the two pools were only 39.5 and 30.0 x 10(3) dpm/microg. High-performance liquid chromatography analysis revealed that only 4% of ALA degraded during 5 minutes in injection solution at pH 6.8. The low incorporation of (3)H-ALA and low specific activity of (3)H-UCB was apparently caused mainly by prior degradation and exchange of labile tritium of the (3)H-ALA and probably by enhanced endogenous ALA synthesis caused by the anesthetic/sedative agents. Revised procedures in the second dog improved the incorporation of (3)H-ALA to 11.9% excreted in bile and the specific activity of the crystalline (3)H-UCB to 122.0 and 50.8 x 10(3) dpm/microg, while urinary excretion of tritium increased to 28.5%. These experiences emphasize possible pitfalls in preparing (3)H-UCB by biosynthetic labeling from (3)H-ALA administered to dogs.
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Affiliation(s)
- J E Bayón
- Department of Physiology, University of León, Spain
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11
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Evans PR, Graham S, Kumar CM. A reply. Anaesthesia 2001. [DOI: 10.1046/j.1365-2044.2001.02279-31.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Evans PR, Graham S, Kumar CM. A reply. Anaesthesia 2001. [DOI: 10.1111/j.1365-2044.2001.2279-31.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Turton-Weeks S, Barone GW, Gurley BJ, Ketel BL, Lightfoot ML, Abul-Ezz SR, Anderson KE. Pretransplant evaluation of a patient with acute intermittent porphyria. Prog Transplant 2001. [PMID: 11949465 DOI: 10.7182/prtr.11.3.61965k72uq73v0vx] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The pretransplant evaluation of a patient with a rare diagnosis requires knowledge of the pathophysiology and the transplant literature. A 55-year-old man presented with hypertensive kidney failure and the clinical diagnosis of acute intermittent porphyria. Complications of acute intermittent porphyria, which is a defect of heme production, are due to the accumulation of heme intermediates often precipitated by medications. Based on animal data, cyclosporine is considered unsafe in patients with acute intermittent porphyria. As part of the pretransplant evaluation, the patient received separate trials of tacrolimus and cyclosporine, which did not stimulate his acute intermittent porphyria. Four months after a kidney transplant, the patient still had no signs of rejection or symptoms of acute intermittent porphyria. This is the first documented patient with acute intermittent porphyria who successfully received a kidney transplant using tacrolimus. Because of individual variations, pretransplant testing of calcineurin inhibitors should be continued in patients with acute intermittent porphyria.
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Affiliation(s)
- S Turton-Weeks
- University of Arkansas for Medical Sciences, Little Rock, Ark., USA
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14
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Affiliation(s)
- M F James
- Department of Anaesthesia, University of Cape Town, South Africa
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15
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16
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Minoda Y, Yoshimine K, Higashi M, Nagata E, Ikeda K, Yoshimura N. Anesthetic management of a patient with variegate porphyria. J Anesth 1997; 11:307-308. [PMID: 28921072 DOI: 10.1007/bf02480750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/1997] [Accepted: 07/07/1997] [Indexed: 10/24/2022]
Affiliation(s)
- Yuko Minoda
- Department of Anesthesiology, Kagoshima City Hospital, 20-17 Kajiya-cho, 892, Kagoshima, Japan
| | - Kowa Yoshimine
- Department of Anesthesiology, Kagoshima City Hospital, 20-17 Kajiya-cho, 892, Kagoshima, Japan
| | - Mikiko Higashi
- Department of Anesthesiology, Kagoshima City Hospital, 20-17 Kajiya-cho, 892, Kagoshima, Japan
| | - Eturo Nagata
- Department of Anesthesiology, Kagoshima City Hospital, 20-17 Kajiya-cho, 892, Kagoshima, Japan
| | - Koji Ikeda
- Department of Anesthesiology, Kagoshima City Hospital, 20-17 Kajiya-cho, 892, Kagoshima, Japan
| | - Nozomu Yoshimura
- Department of Anesthesiology and Critical Care Medicine, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, 890, Kagoshima, Japan
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17
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Affiliation(s)
- G H Elder
- Department of Medical Biochemistry, University of Wales College of Medicine, Heath Park, Cardiff, UK
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18
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Pivalizza EG, Abramson DC, Gottschalk LI. Porphyria, Cardiopulmonary Bypass, and Volatile Anesthetics. Anesth Analg 1996. [DOI: 10.1213/00000539-199609000-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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19
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Pivalizza EG, Abramson DC, Gottschalk LI. Porphyria, cardiopulmonary bypass, and volatile anesthetics. Anesth Analg 1996; 83:658. [PMID: 8780302 DOI: 10.1097/00000539-199609000-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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20
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Abstract
The report of the Expert Maternity Group 'Changing Childbirth' (The Cumberlege Report) advocates a greater role for midwives in the care of the low risk pregnant woman, and has promoted much discussion about the future development of maternity services in the UK. At Leicester Royal Infirmary NHS Trust the 'Home from Home' delivery scheme provides midwifery-led antenatal and intrapartum care of women with uncomplicated pregnancies. We have performed a retrospective review of the requirements for anaesthetic services in this unit. During the 12 month review period 1610 women were admitted to the 'Home from Home' delivery scheme in labour. One hundred and eighty one women subsequently received anaesthetic intervention. Of this group, 137 (77.0%) required an epidural, 17 (9.6%) a spinal, 18 (10.1%) a general anaesthetic, 5 (2.8%) an epidural and a general anaesthetic and 1 (0.6%) an epidural and a spinal. Our results demonstrate that low risk pregnant women in labour being cared for in a midwifery led unit have a considerable need for anaesthesia and analgesia.
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Affiliation(s)
- J A Pickett
- Department of Anaesthesia, Leicester Royal Infirmary NHS Trust, Leicester, UK
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21
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Affiliation(s)
- J W Sear
- Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Headington, United Kingdom
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22
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Yamamori Y, Sumi M, Yamanaka M, Kosaka Y. Safety of isoflurane and epidural anesthesia in a patient with hereditary coproporphyria. J Anesth 1996; 10:80-2. [PMID: 23839560 DOI: 10.1007/bf02482076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/1995] [Accepted: 08/31/1995] [Indexed: 11/30/2022]
Affiliation(s)
- Y Yamamori
- Department of Anesthesiology, Shimane Medical University, 89-1 Enya, 693, Izumo, Japan
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23
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Stevens JJWM, Kneeshaw JD. Mitral Valve Replacement in a Patient with Acute Intermittent Porphyria. Anesth Analg 1996. [DOI: 10.1213/00000539-199602000-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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24
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Affiliation(s)
- J J Stevens
- Department of Anaesthesia, Papworth Hospital, Papworth Everard, Cambridge, United Kingdom
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25
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Abstract
Four hereditary types of porphyria are now classified as acute porphyrias. Enzymatic defects result in accumulation of porphyrin precursors (usually ALA and PGB). The quantity of these precursors may be normal or slightly increased in latent periods but increase to toxic levels during a porphyric crisis. Iatrogenic induction of ALA synthetase by administration of certain triggers (classically barbiturates) is only one of several factors which contribute to porphyric crisis. Signs and symptoms of acute porphyric attack consist primarily of neurologic dysfunction, which occurs secondary to neurotoxicity of ALA or diminished intraneuronal heme levels. Appropriate anesthetic management of porphyria requires knowledge of the type of porphyria (acute vs non-acute), assessment of latent versus active (crisis) phase, awareness of clinical features of porphyric attack, and knowledge of safe pharmacologic intervention.
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Affiliation(s)
- N F Jensen
- Department of Anesthesiology, University of Iowa College of Medicine, Iowa City 52242
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26
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27
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Sneyd JR, Kreimer-Birnbaum M, Lust MR, Heflin J. Use of sufentanil and atracurium anesthesia in a patient with acute porphyria undergoing coronary artery bypass surgery. J Cardiothorac Vasc Anesth 1995; 9:75-8. [PMID: 7718759 DOI: 10.1016/s1053-0770(05)80060-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- J R Sneyd
- Department of Anesthesiology, University of Michigan, Ann Arbor, USA
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28
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Abstract
A patient with acute intermittent porphyria was anaesthetised with propofol for a minor orthopaedic procedure. Postoperative urinary porphyrins were markedly raised compared to pre-operative values, although the patient remained clinically well. Caution should continue to be exercised when propofol is used in patients with acute porphyrias.
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Affiliation(s)
- D Elcock
- Department of Anaesthesia, Lincoln County Hospital
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29
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Blanloeil Y. [Acute hepatic porphyria and Diprivan]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1994; 13:485-9. [PMID: 7872528 DOI: 10.1016/s0750-7658(05)80678-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Propofol may be used without any restriction in all cases of asymptomatic hepatic porphyria, as a bolus injection for induction and maintenance of anaesthesia and as a continuous infusion to produce anaesthesia of short and medium duration. If in doubt as to the absolute safety of propofol in case of symptomatic hepatic porphyria, preference has to be given to neuroleptanalgesia, benzodiazepines and muscle relaxants. If propofol is to be used, treatment with haematin should be readily available. In all cases, it is essential to determine porphyrins and their precursors prior to and after surgery. Urine collection should strictly adhere to the recommended procedure: sterile conditions, protected from light and high temperature. Any abnormal reaction after the administration of a drug, especially propofol, should be notified to and discussed with the National Porphyria Centre (Centre Français des Porphyries). In case of symptomatic hepatic porphyria the use of propofol should always be notified to the National and to the European Porphyria Centres (Orphan Europe).
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Affiliation(s)
- Y Blanloeil
- Service d'Anesthésie et Réanimation Chirurgicale, Hôpital G. et R. Laennec, Nantes
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