Use of metaraminol in patients with Familial Mediterranean Fever


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We were recently involved in the management of a 38-year-old male who was admitted to our hospital for an elective surgical procedure that mandated general anaesthesia. He was also known to suffer with Familial Mediterranean Fever (FMF). FMF is a hereditary inflammatory disease characterised by self-limited recurrent attacks of fever and serositis [1]. The recurrent attacks of fever are accompanied by severe abdominal pain, arthritis or chest pain along with a marked increase in acute phase reactants [1]. Inheritance is autosomal recessive and it affects mainly Jews, Turks, Arabs and Armenians [2]. FMF crises are characterised by an influx of polymorphonuclear leucocytes into the inflamed regions [2].

A PubMed search uncovered that attacks could be precipitated by intravenous metaraminol [3]. Indeed, the metaraminol provocative test is considered a specific diagnostic test for FMF: a 10-mg infusion of metaraminol is followed within 48 h by a typical disease-like attack [3]. As metaraminol is widely used in anaesthetic practice and cumulative doses in excess of 10 mg can be administered if hypotension is protracted, it is quite likely this could trigger a FMF crisis postoperatively. The metaraminol-induced symptoms do not occur in patients on prophylactic colchicine therapy [3]. However, colchicine treatment is often complicated by frequent gastrointestinal side-effects, reducing patient compliance [4]. We would therefore suggest anaesthetists remain vigilant to the potential risks associated with the use of metaraminol in this group of patients, especially those not taking colchicine regularly.