Use of metaraminol in patients with Familial Mediterranean Fever

Authors


  • A response to a previously published article or letter can be submitted to the Online Correspondence section at http://www.anaesthesiacorrespondence.com. A selection of this correspondence is published several times a year in Anaesthesia. All correspondence intended for publication in Anaesthesia should be addressed to Dr David Bogod, Editor-in-Chief, and submitted as an e-mail attachment to anaesthesia@nottingham.ac.uk. For multi-author letters, a covering letter signed by all authors must be submitted either by post, fax (44 (0) 115 962 7670) or by e-mail as a scanned document before correspondence can be published. Alternatively, letters may be submitted typewritten on one side of paper, double spaced with wide margins to Anaesthesia, 1st Floor, Maternity Unit, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK. All paper submissions must include a signed covering letter, a disc or CD-ROM with a Word for Windows or .rtf version of the letter and an email address for the corresponding author. Copy should be prepared in the usual style of the Correspondence section. Authors must follow the advice about references and other matters contained in the Author Guidelines at http://www.blackwellpublishing.com/journals/ana/submiss.htm. Correspondence presented in any other style or format will be returned to the author for revision.

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.

Ancillary