Anesthetic management of pregnant women with sickle cell disease — effect on postnatal sickling complications

Abstract

Purpose: Currently, there is no consensus regarding the choice of anesthetic technique for parturients with sickle cell disease (SCD). The aim of the study was to determine the impact of the anesthetic technique on the occurrence of postnatal sickling complications. Methods:We reviewed the charts of all pregnant women with SCD who had given birth in our institution between January 2002 and January 2007. Data related to pregnancy and anesthetic management and complications related, or unrelated, to SCD were recorded. Full blood count and lactate dehydrogenase values were recorded on the day of delivery. Risk factors for postnatal sickling complications were evaluated using a logistic regression analysis to estimate odds ratios (OR) and their 95% confidence intervals (95% CI). Results:Fourteen of the 55 women (24%) experienced at least one postnatal sickling complication. Women who developed postnatal sickling complications were found to have a higher leukocyte count (17.0 ± 6.1 × 10 9 ·L -1 vs 12.8 ± 4.4 ×10 9 ·L -1 , P = 0.008) and a lower hemoglobin level (7.8 ± 1.1 vs 8.9 ± 1.0 g.dL -1 , P = 0.002). General anesthesia (OR = 16.0; 95% CI, 1.6 to 165.6) and a leukocyte count ≥ 15 × 10 9 ·L -1 (OR = 8.4; 95% CI, 1.6 to 44.5) were identified as risk factors. Neuraxial anesthesia and use of ephedrine were not identified as risk factors. There were no deaths. Conclusion: Our study suggests that general anesthesia could be associated with postnatal sickling complications, even when the severity of illness was taken into account.

Spinal versus general anesthesia for Cesarean section in patients with sickle cell anemia

“…GA was identified as a risk factor for maternal complications in women with SCA. Camous et al [ 3 ] considered GA to be a risk factor for postnatal sickling (acute chest syndrome, vaso-occlusive crisis, and stroke). However, neuraxial anesthesia was not identified.…”

“…Therefore, adequate hydration before spinal anesthesia, uterine displacement, and prompt diagnosis and treatment of hypotension with fluid boluses and ephedrine are important measures to minimize the duration and occurrence of hypotension. Interestingly, despite the vasoconstriction caused by ephedrine, which is critical for patients with SCA, Camous et al [ 3 ] found that ephedrine was not a risk factor for postnatal sickling complications in parturients with SCA.…”

“…Proper planning and optimal perioperative preparation are keys to the successful management of patients with sickle cell disease. There is no consensus regarding the choice of anesthetic technique for parturients with SCA because the impact of the anesthetic technique may affect the occurrence of sickling complications [ 3 ].…”

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

“…Intraoperative hemodynamics was maintained to avoid hypotension and tachycardia. Intraoperative ABG showed pH at 7.409, pCO 2 -30.6, pO 2 -91.1, HCO 3 -20.7, and saturation at 99.1%.…”

Acute Chest Syndrome in Sickle Cell Disease Patients Post Caesarean Delivery

“…Since ACS may occur as a postoperative complication in patients with SCD, especially following abdominal surgery (4,14), vaginal delivery is preferred over Caesarean delivery when possible.…”