Coronary artery bypass graft surgery in a patient with haemoglobin SC disease

Abstract

SummaryTwenty-seven patients received boron neutron capture therapy during craniotomy at our research reactor from 1991 to 1999. This is a form of intra-operative radiation therapy, which uses neutrons from a nuclear reactor. There are three additional major problems to anaesthetists: boron neutron capture therapy must be given beside the nuclear reactor, with no hospital facilities; neutrons cannot be shielded effectively by ordinary protectors; and neutrons are detrimental to metal devices and especially to electrical appliances. Boron neutron capture therapy has been adopted as an effective therapy for glioblastoma/astrocytoma, but special considerations are required for anaesthesia.

Successful Combined Heart and Kidney Transplantation in a Patient With Sickle-cell Anemia

“…Some investigators have reported their experience of cardiac surgery in SCD patients with normal left ventricular function. 9,10 To date, there has been no report of heart transplantation and only one report of combined liver and kidney transplant for a patient with SCD. 11 Most clinical experience with SCD patients has involved renal transplantation.…”

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

“…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% .…”

“…Intraoperative monitoring varies. Per standard anesthetic care, blood pressure, cardiac rhythm and rate and oxygenation are monitored strictly to avoid hypoxia . Some groups perform more invasive systematic monitoring such as the continuous measurement of central venous pressure, arterial blood pressure, regular arterial blood gas exchange and/or urine output determination (by Foley catheterization) .…”

“…Vasoconstricting amines or other similar drugs, which are theoretically associated with a risk of peripheral vascular stasis, should if possible not be among the first line approaches to hypotension according to many . Hydration to avoid hyperviscosity and dehydration is considered essential . Hypothermia is not tolerated .…”

Preoperative Exchange Transfusion for Sickle Cell Disease Patients Undergoing Open-Heart Surgery: An Exception to the Rule

“…Currently, preoperative transfusion in SCD is recommended only in pronounced preexisting anemia. The preoperative Hb level has been identified as a strong predictor of perioperative blood transfusion in patients undergoing cardiac surgery 5,6 …”