Porfirili bir gebede sezaryen operasyonunda Epidural anestezi

Porfiriler, hem biyosentez yolunda enzim eksikliği ile karakterize, yaşamı tehdit edebilen ve kalıtımsal geçişli bir hastalıktır. Porfirili hastalarının anestezisi güvenli ve porfirojenik olmayan ajanların ve metotların bilinmesini gerektirir. Anestezikler, cerrahi ve gebeliğin her biri akut porfiri krizini tetikleme riski içermektedir. Bu olgu sunumunda; sorunsuz sezaryen operasyonu geçiren iki porfirili gebede, bupivakain ve fentanil ile uygulanan epidural anestezi uygulaması gözden geçirilmiştir.

Epidural anesthesia for caesarian section in a pregnant with porphyria

Porphyria which is characterized by enzyme deficiency in heme biosynthesis pathway is life-threatening and genetically inherited disease. Anesthesia of a patient with porphyria requires knowledge about non-porphyrogenic agents and safe methods. Each of anesthetics, surgery and pregnancy has the risk of triggering acute porphyria crisis. In this case report; the epidural anesthesia management with bupivacaine and fentanyl in two pregnant women with porphyria who had undergone cesarean operation without any problems is valuated.

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1. Rigal JC, Blanloeil Y. Anaesthesia and porphira. Minerva Anestesiol 2002; 68: 326-631.
2. Jensen NJ, Fiddler DS, Striepe V. Anesthetic Considerations in porphyrias. Anesth Analg 1995; 80: 591-599.
3. Chawda PM, Arora D, Kumar P. Caesarean section in a porphyria pregnant patient under regional anaesthesa. Indian J Anaesth 2003; 47: 220-221.
4. Mehta M, Rath GP, Padhy UP, Marda M, Mahajan C, Dash HH. Intensive care management of patients with acute intermittent porphyria: Clinical report of four cases and review of literature. Indian J Crit Care Med 2010; 14: 88-91.
5. Cuquemelle É, Ehrmann S, Razazi K, Deybach JC, Brun-Buisson C, Thille AW. An atypical case of Guillain-Barré syndrome: acute intermittent porphyria. Intensive Care Med 2012; 38: 913-914.
6. Brennan L, Halfacre JA, Woods SD. Regional anaesthesia in porphyria. Br J Anaesth 1990; 65: 594.
7. James MF, Hift RJ. Porphyrias. Br J Anaesth 2000; 85: 143-153.
8. Parikh RK, Moore MR. Effect of certain anaesthetic agents on the activity of rat hepatic delta-aminolaevulinate synthase. Br J Anaesth 1978; 50: 1099-1103.
9. McNeill MJ, Bennet A. Use of regional anaesthesia in a patient with acute porphyria. Br J Anaesth 1990; 64: 371-373.
10. Dover SB, Plenderleith L, Moore MR, McColl KE. Safety of general anaesthesia and surgery in acute hepatic porphyria. Gut 1994; 35: 1112-1115.
11. Srugo I, Said E, Korman S, Jaffe M. Acute intermittent porphyria - an unusual cause of "surgical" abdomen. Response to propranolol therapy. Eur J Pediatr 1987; 146: 305-308.
12. Harrison GG, Moore MR, Meissner PN. Porphyrinogenicity of etomidate and ketamine as continuous infusions. Br J Anaesth 1985; 57: 420-423.
13. Famewo CE. Induction of anesthesia with etomidate in a patient with acute intermittent porphyria. Can Anaesth Soc J 1985; 32: 171-173.
14. Kanbak M. Ketamine in porphyria. Anesth Analg 1997; 84: 1395.
15. Sarantopoulos CD, Bratanow NC, Stowe DF, Kampine JP. Uneventful propofol anesthesia in a patient with coexisting hereditary coproporphyria and hereditary angioneurotic edema. Anesthesiology 2000; 92: 607-609.