Anaesthesia for peculiar cells'a century of sickle cell disease

Abstract

Sickle cell disease is a congenital haemoglobinopathy with a high incidence of perioperative complications. Traditional anaesthetic management, based largely on extrapolation from biochemical models, has emphasized avoidance of red cell sickling to prevent exacerbations of the disease. This historical review outlines the evolution of the traditional approach to sickle cell pathology, assesses the validity of this model, describes the emergence of the concept of the disease as one defined by chronic inflammatory vascular damage, and outlines the practical implications of this new approach.

Anesthetic management of pregnant women with sickle cell disease — effect on postnatal sickling complications

“…20 Increased sickle erythrocyte adhesion to the endothelium has been postulated to be an important factor in the initiation and/or pro-gression of vaso-occlusive crises. 3,13,20 However, the use of ephedrine was not identified as a risk factor for postnatal sickling complications.…”

“…2,[10][11][12][13] In a review on SCD and anesthesia published in 1988, the authors stated that, "the choice of regional or general anesthesia for obstetric patients depends on the patient's general condition and the preference of the anesthesiologist, rather than specific indication". 10 According to others, regional anesthesia could be safely used for Cesarean delivery.…”

“…9 Whatever the choice of anesthetic technique, it is important to avoid hypothermia, hypoxemia, hypovolemia, acidosis, and hypotension. 1,[10][11][12][13] Ephedrine is an acceptable drug for normalizing blood pressure. 9 It has been speculated that pressors, which can produce vasoconstriction and stasis, should be avoided whenever possible in SCD, 10 because these conditions may increase the risk of sickling.…”

“…9 It has been speculated that pressors, which can produce vasoconstriction and stasis, should be avoided whenever possible in SCD, 10 because these conditions may increase the risk of sickling. 3,13 Apart from its vasoconstrictive effect, ephedrine, like epinephrine, 20 could also initiate or exacerbate vaso-occlusion via activation of red cell adhesion. 20 Increased sickle erythrocyte adhesion to the endothelium has been postulated to be an important factor in the initiation and/or pro-gression of vaso-occlusive crises.…”

“…9 Nevertheless, no consensus exists concerning the anesthetic care of parturients with SCD. [10][11][12][13] The aim of this retrospective study was to determine the possible relationship between anesthetic technique and the occurrence of postpartum sickling complications.…”