Anesthetic management of a patient with polycythemia vera for neurosurgery

Abstract

Polycythemia vera (PV) is a myeloproliferative disorder characterized by excess red cell clonality. The increased number of red blood cells can lead to increased viscosity of the blood and ultimately compromise the blood supply to the end organs. Thromboembolic and hemorrhagic complications can also develop. Patients with PV presenting with neurological diseases that require surgical intervention are at an increased risk due to various factors, such as immobility, prolonged surgical time, hypothermia and dehydration. We report anesthetic management of a patient with PV who underwent neurosurgical intervention for vestibular schwannoma excision.

Polycythaemia Vera and Coronary Artery Bypass Graft Surgery: A Systematic Review of the Literature

“…Ural et al recommended additional cytoreductive therapy in these high-risk patients, which is supported in a report by Al-Fadhli et al [11,41] and in a recent randomised controlled trial (RCT) reporting significantly lower mortality and major thrombotic events in patients with a haematocrit level less than 45% when achieved by phlebotomy and/or hydroxyurea. Notably, this study did not stratify for perioperative CABG patients [32]. Other controversial areas in post-CABG patients include the timing of drug reduction to single antiplatelet therapy or cytoreductive therapy.…”

“…However, the significance of this in patients who have undergone 'on-pump' surgery remains unclear. Inotropic agents can maintain blood pressure and cardiac output to minimise stasis and low sheer stress in microcirculation [32]. Plasma viscosity can also be increased by poor core body temperature maintenance; as reported, a 1 C drop in core body temperature can increase blood viscosity by 2%, which is not favourable in PV patients [10,32].…”

Successful perioperative management of a patient with erythropoietin-producing uterine myoma

“…Polycythemia vera also occurs so rarely that there is currently insufficient evidence to establish a standard anesthetic management strategy. However, a few reports regarding anesthetic management of polycythemia vera can be found [3,4], Fig. 1 Changes in hemoglobin and erythropoietin levels.…”

“…While some reports are available regarding the anesthetic management of polycythemia vera [3][4][5][6], to the best of our knowledge, there are no previous reports regarding the anesthetic management of erythropoietin-producing uterine myoma. Herein, we report the successful administration of general anesthesia to a patient with erythropoietin-producing uterine myoma.…”