Uso de sugammadex en la porfiria aguda intermitente

Abstract

Porphyrias are a group of rare diseases, which include acute intermittent porphyria. It is essential for the anesthesiologist to identify acute porphyrias and to recognize a porphyric crises. These can be triggered by several factors, which can be present throughout the perioperative period. A 70-year-old male, ASA III, with a personal history of acute intermittent porphyria and ischemic heart disease, scheduled for laparoscopic sigmoidectomy. Prolonged fasting, dehydration and potentially porphyrinogenic drugs were avoided. General anesthesia was induced with fentanyl, lidocaine, propofol and rocuronium and maintained with desflurane. The decision to reverse the neuromuscular blockade with sugammadex was considered due to the benefits over risks of this drug when compared to neostigmine (associated with atropine) and the description of its use without harm in two cases of variegate porphyria. The following paper emphasize the importance of careful anesthetic management throughout the perioperative period and describe a case of successful reversal of neuromuscular block with sugammadex, highlighting this case as the first case reported of its use in acute intermittent porphyria.