A 26-year-old woman with acute intermittent porphyria requires laparotomy for intestinal obstruction. Which induction agent is the safest choice?

• A Propofol ✓
• B Etomidate
• C Thiopentone sodium
• D Midazolam followed by ketamine

Explanation

Porphyric crises are precipitated by drugs that induce hepatic cytochrome P450 enzymes and increase delta-aminolaevulinic acid synthase activity. Barbiturates such as thiopentone are classic triggers and are absolutely avoided, as is etomidate, which is also implicated. Propofol is considered safe and is the induction agent of choice in porphyria. Ketamine has been used without reported crisis, but propofol carries the strongest safety record and avoids combining agents unnecessarily. Regional anaesthesia where feasible is also acceptable.

Reference: Morgan and Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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