Anesthetic management of a patient with sickle cell disease for common bile duct exploration

Abstract

Patients with sickle cell disease (SCD) may present to the anesthetist in different clinical settings like perioperative care, management of acute painful crisis and intensive therapy for acute respiratory failure. We describe the successful management of a 34-year-old female patient with SCD, posted for cholecystectomy with common bile duct exploration under general and epidural anesthesia. The importance of preoperative stabilization and careful anesthetic strategy is emphasized.

Perioperative care of children with sickle cell disease: A systematic review and clinical recommendations

“…The role for antibioprophylaxis is discussed by many, and two strategies seem to co‐exist in the literature. There are authors recommending prophylaxis according to type of surgery, and others adapting it to the individual patients' medical histories . As a standout, splenectomy needs specific considerations, including preoperative immunizations against encapsulated bacteria, as in the context of asplenia .…”

“…Some authors advocate for preoperative transfusion without giving a threshold, despite evidence from the abovementioned RCTs. Exchange transfusions (manual and automated) for a leve of HbS <30% is recommended for high risk surgery either preoperatively, or on cardiopulmonary bypass . In cardiac pulmonary bypass, some authors suggest a stricter HbS limit of <5% .…”

Anesthesia Management of a Patient with Sickle Hemoglobinopathy and Mitral Stenosis for Emergency Lower (Uterine) Segment Cesarean Section

“…Exchange transfusion is generally recommended before major surgical interventions in order to minimize sickling and reduce the circulating HbS concentration below 30%. 4 Prophylactic transfusion significantly reduced the incidence of painful crises of SCD (p < 0.01) and substantially reduced the cumulative incidence of other complications of this disorder.…”

“…Also, maintenance of normal body temperature is desirable to minimize vasoconstriction and associated circulatory stasis. 4 Preoperative need for exchange transfusion depends on the general condition of the patient and the type of surgical procedure. Exchange transfusion is generally recommended before major surgical interventions in order to minimize sickling and reduce the circulating HbS concentration below 30%.…”

Dexmedetomidine as sedative and analgesic in a patient of sickle cell disease for total hip replacement

“…[1] Sickled cells have increased adherence to endothelium leading to micro-vascular infarction and pain, the basis of VOC. [2] The risk intrinsic to the type of surgery should be considered. Among orthopaedic procedures, hip surgery and hip replacement are associated with a high risk of complications.…”