A patient with porphyria can usually undergo surgery provided certain precautions are taken. However, surgery should only be performed if it is necessary and likely to have benefits that outweigh any risks.
Risk factors for surgery:
(1) history of acute porphyria (associated with the neurovisceral types - AIP, VP, HCP and ALADD) AND frequent attacks
(2) prolonged fasting and stress
(3) administration of triggering medications
Need
Recommendation
premedication
atropine and morphine
induction agent for anesthesia
propofol or ketamine
muscle relaxation
D-tubocurarine or suxamethonium
general anesthesia
nitrous oxide AND intravenous narcotics AND muscle relaxants
regional anesthesia (preferred if possible)
bupivacaine
analgesia
morphine, diamorphine, pethidine, or fentanyl
carbohydrate source
intravenous infusion of dextrose starting before surgery and continuing until the patient is able to tolerate a regular diet
If the patient has a problem with photosensitivity, then prolonged exposure to bright operating room lights may be a hazard.
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