Sickling Dynamics of Red Blood Cells and Other Physiologic Studies During Anesthesia

Abstract

Nineteen patients with electrophoretically proven sickle cell diseases were studied prospectively at intervals, using halothane, methoxyflurane, cyclopropane, and fluroxene. Simultaneous venous and arterial samples were taken from the same arm in heparinized syringes at the sampling intervals and analyzed for blood gases, hematocrit, and percent sickle cells. Measurements of blood pressure, pulse, temperature, tidal volume, minute ventilation, and other significant data were recorded. There were no anesthetic deaths, and the morbidity seen was an extension of pre-existing pathology. Sickling was found to be greatly reduced in both arterial and venous blood during anesthesia, with the greater reduction in venous blood. Following anesthesia, sickling returned toward, but often did not reach, pre-anesthetic levels. Blood-gas measurements reflected the slightly increased ventilation and considerably increased inspired oxygen during anesthesia. Other measurements were not remarkable.

First Experience in Living Liver Donation From Donors With Sickle Cell Trait

“…We felt safe following the best practice paper ( Hematology Reviews , 2009) advice to reduce HbS levels below 30%. 23 Fourteen out of 20 donors had HbS levels above 30% and therefore underwent (slightly heterogeneous) sequential phlebotomy or blood transfusion 2 d preoperatively to achieve the aimed HbS levels. No sickling- or transfusion-related complications were seen.…”

“…Open-heart surgery, which causes hypoxia and hypothermia and modern liver resection causing hypovolemia, can be performed safely, and exercise collapse associated with SCT has not been reported. [29][30][31] Because of the likelihood of sickling during procedures with low Pao 2 levels, 11,22,32 the protocol for open-heart surgery at our center is more aggressive, and up to now, SCT and SCD patients are equally subjected to it. No increased incidence of sickling was reported in a retrospective study of 47 patients after aiming for exchange transfusions to achieve HbS <10% and hematocrit >30.…”

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

“…It is agreed that patients should be warmed, well hydrated, well oxygenated and mildly alkalotic to avoid conditions that could lead to relative regional hypoxia, increased sickling and compromised oxygen delivery to tissues. Limited evidence exists that sickling may be temporarily reduced during general anaesthesia [6].…”

Surgery in patients with hemoglobin SC disease

“…It is agreed upon that patients should be warmed, well hydrated, well oxygenated and mildly alkalotic to avoid conditions that could lead to relative or regional hypoxia, increase sickling, and compromised oxygen delivery to tissues [16][17][18][19][20][21][22]. While there may be theoretical advantages of regional anesthesia over general regimens, compensatory vasoconstriction may occur in unanesthetized areas during regional anesthesia [23], and there is even limited evidence that sickling may be temporarily reduced during general anesthesia [24]. Most authors recommend choosing the anesthetic regimen most appropriate for the surgical procedure [18,21].…”