ABSTRACT
Acute intermittent porphyria (AIP) is an inherited metabolic disorder caused by deficiency of porphobilinogen deaminase, an enzyme found in the synthetic pathway of heme. Acute attack of AIP may be precipitated by many factors during operation and anesthesia, including fasting, dehydration, stress, infection, and drugs. Acute attack of AIP is likely fatal. Therefore, the drugs recommended as being safe in anesthesia for porphyria patients are up-to-dately refreshed and renovated and the identification of whether a drug is safe or not is based on cumulative anecdotal experiences. Here, we report the safe use of rocuronium and sevoflurane for long exposure in a patient affected with acute intermittent porphyria.
Subject(s)
Androstanols/pharmacology , Anesthetics, Inhalation/pharmacology , Methyl Ethers/pharmacology , Neuromuscular Nondepolarizing Agents/pharmacology , Porphyria, Acute Intermittent/complications , Female , Humans , Middle Aged , Rocuronium , SevofluraneABSTRACT
We report a case of pulmonary artery perforation induced by Swan-Ganz catheter. Brisk massive airway hemorrhage occurred after withdrawl of the Swan-Ganz catheter post cardiopulmonary bypass. Early recognition, immediate re-establishment of cardiopulmonary bypass, lobectomy of the sanguineous lobe subsequent to rupture of the involved pulmonary artery, and thorough bronchial toilet were the major determinants contributing to successfully rescuing the patient's life. She was discharged uneventfully in spite of high mortality rate of the catheter-induced pulmonary artery perforation.
