Ultrasound-Guided Regional Anesthesia in a Glucose-6-Phosphate Dehydrogenase (G6PD)-Deficient Geriatric Trauma Patient

Abstract

Objective: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic enzymatic disorder causing hemolytic anemia. Exposure to drugs is considered to be the most common cause of acute hemolysis in patients with G6PD deficiency. Experience with regional anesthesia, in particular peripheral nerve blocks, is rarely described in patients with G6PD deficiency, but is of great clinical interest. For this reason, we now report on the successful management of ultrasound-guided axillary brachial plexus block in a patient with geriatric G6PD deficiency. Case report: A female, 75-year-old geriatric trauma patient with G6PD deficiency and a fracture of the left forearm, was scheduled for osteosynthesis of the left forearm. For surgery regional anesthesia with ultrasound-guided axillary brachial plexus block with 30 mL bupivacaine 0.5% was established. Surgical operation und postoperative course were uneventful and with no signs of hemolysis. Conclusion: Ultrasound-guided axillary brachial plexus block with bupivacaine was a safe and effective technique in this patient with G6PD deficiency. Peripheral nerve block is a major analgesic approach and of great value for anesthesiologists and surgeons, especially in our aging and multimorbid society.

Anaesthesia for a child with glucose-6-phosphate-dehydrogenase deficiency: a case report

“…In several cases, bupivacaine has been used without increased risk of haemolysis. 7,8 NADPH which is deficient in these patients is useful to reduce methemoglobin, an ineffective variant of haemoglobin. Moreover, methylene blue used in the treatment of methemoglobinaemia, is not efficacious in G6PD deficient patients.…”

Anesthetic Management in a Patient With Glucose-6-Phosphate Dehydrogenase Deficiency Undergoing Coblation Adenoidectomy With Septoplasty and Turbinectomy

“…Hemolysis can be happening after exposure to many factors such as fava beans, infections, metabolic conditions such as diabetic ketoacidosis, metabolic acidosis, hyperglycemia, hypoglycemia and hypothermia, and have been all over reported previously [ 1 , 9 - 11 ]. Furthermore, certain types of medication such as antimicrobials (sulfonamides, nitrofurantoin, and chloramphenicol), non-steroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, diuretics containing sulfonamide, insulin, oral hypoglycemic agents, and ranitidine, are known to lead to hemolytic anemia [ 5 , 6 , 9 - 11 ].…”

“…At the same time, anesthetic drugs such as diclofenac, metoclopramide, lidocaine, methylene blue, and prilocaine are contraindicated in patients with G-6-PD deficiency [ 11 , 12 ]. While glycopyrrolate, fentanyl, sufentanil, tramadol, ketamine, propofol, thiopental, halothane, nitrous oxide, rocuronium, succinylcholine, neostigmine, bupivacaine, and heparin are reported previously as it can be administrated safely in patients with G-6-PD deficiency [ 1 , 4 , 6 , 11 ]. However, there are anesthetic agents still controversy such as sevoflurane and midazolam [ 6 ].…”

“…Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency is an enzymopathy that leads to red blood cells (RBCs) hemolysis [ 1 , 2 ]. It is the most common enzymopathic disorder of RBCs [ 3 , 4 ].…”

Perioperative management in a case of glucose-6-phosphate dehydrogenase deficiency undergoing orthopaedic surgery

“…Benzodiazepine, propofol, ketamine, fentanyl, codeine, paracetamol, inhalational agent namely isoflurane and sevoflurane are safe for perioperative use,[ 1 3 ] α 2 receptor agonist, dexmeditomedine have also been used successfully for maintenance of anesthesia. [ 4 ] Very few case reports mentions the use of local anesthetic, bupivacaine[ 5 ] for regional anesthesia but lignocaine has been reported to cause hemolysis in G6PD deficiency. Epidural analgesia was the superior option in our case, but could not be implemented in view of very limited data on safety of local anesthetics and predilection of severe hemolysis.…”