Effect of prophylactic vitamin D on anesthetic outcome in children with sickle cell disease

Abstract

Background:Few previous studies proved that complications related to sickle cell disease (SCD) were common with regional anesthesia compared with general anesthesia while others reported no differences. This study was carried out to evaluate the role of prophylactic vitamin D on anesthetic outcome among male children with SCD undergoing circumcision.Materials and Methods:A comparative study was carried out on 58 children undergoing circumcision with the regional block under light general anesthesia. The study sample was classified into two groups: one group received daily 400 IU vitamin D for 6 months before surgery while the other group without vitamin D. All patients were followed regarding the post-operative analgesia and the incidence of post-operative SCD related complications (acute chest syndrome, painful crisis and cerebrovascular accident). Data were analyzed with Statistical Package for Social Sciences version 13, produced by IBM SPSS, Inc. in Chicago, Illinois, USA.Results:There was a highly significant difference between the two groups (P < 0.001) regarding first analgesic request and total analgesic consumption per day: there was delayed analgesic request and less total analgesic consumption per day in vitamin D group. Comparison of post-operative sedation scores showed highly significant difference (P < 0.001) between the two groups, Sedation scores was increased significantly in vitamin D group. This study also reported that the administration of vitamin D was associated with less noticeable post-operative SCD complications.Conclusion:The use of prophylactic vitamin D in SCD will result in delayed post-operative analgesic request and less total analgesic requirement. Administration of vitamin D was also associated with less post-operative complications.

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

“…The systematic preoperative assessment of SCD patients varies considerably in its implementation and/or description. As expected, collecting a medical history and performing a physical examination is a standard recommendation . In particular, the documentation of a personal pain management history is part of some assessments, and aims to facilitate postoperative interventions and decision‐making in non‐opioid naïve patients .…”

“…In particular, the documentation of a personal pain management history is part of some assessments, and aims to facilitate postoperative interventions and decision‐making in non‐opioid naïve patients . Some authors suggest a complete clinical examination of the nervous system and imaging, such as transcranial Doppler ultrasound, cerebral angiography or MRI if indicated . A chest radiograph is often performed as part of the work‐up: universally, or only if and when clinically indicated .…”

“…Some authors suggest a complete clinical examination of the nervous system and imaging, such as transcranial Doppler ultrasound, cerebral angiography or MRI if indicated . A chest radiograph is often performed as part of the work‐up: universally, or only if and when clinically indicated . Laboratory investigations are generally requested in a procedure‐specific fashion, and include blood counts, HbS % determination (by electrophoresis or high‐performance liquid chromatography), metabolic, liver and kidney testing panels, coagulation studies and blood gas analyzes .…”

“…A chest radiograph is often performed as part of the work‐up: universally, or only if and when clinically indicated . Laboratory investigations are generally requested in a procedure‐specific fashion, and include blood counts, HbS % determination (by electrophoresis or high‐performance liquid chromatography), metabolic, liver and kidney testing panels, coagulation studies and blood gas analyzes . Electrocardiogram and echocardiography are frequently performed.…”

Safety and Efficacy of High-dose Daily Vitamin D3 Supplementation in Children and Young Adults With Sickle Cell Disease

“…A significant increase in 25(OH)D and decrease in pain days/week were reported, however the percentage of subjects in each vit D status category after supplementation was not assessed. In a double-blind study focused on post-operative anesthesia Shams et al 36 randomized 58 children with SCD (42 hemoglobin SS, 5 hemoglobin SC, 11 sickle beta plus thalassemia) undergoing circumcision to 400 IU/day vit D (D 2 or D 3 not specified) for 6 months before surgery or no vit D. Those in the vit D group showed a delay in post-operative analgesic request, less total analgesic requirement and fewer complications. Although the authors demonstrated a significant increase in 25(OH)D with supplementation in the vit D vs. no vit D groups, the percentage of subjects with 25(OH)D concentrations in the optimum, insufficient and deficient ranges was not reported either pre- or post-operative.…”