Abstract
Summary Background: Children with sickle cell disease frequently undergo surgical procedures that are associated with acute exacerbations of the disease. Current perioperative management practices are unclear. Objectives: We aimed at describing the current management. Methods: We conducted an electronic survey of North American members of the Society for Pediatric Anesthesia, in which we asked about their perioperative management of sickle cell disease. Results: The response rate to valid addresses was 25% (n = 510/2006). In four scenarios, (a patient with mild disease undergoing a minor procedure; a patient with mild disease undergoing a more invasive procedure; a patient with severe disease undergoing a minor procedure; and a patient with severe disease undergoing a more invasive procedure) 80%, 38%, 27%, and 16% of respondents, respectively, would rely on oral fluids to hydrate patients during the preoperative fast, while 13%, 34%, 44%, and 59%, respectively, would use intravenous fluid. For the same four scenarios, 64%, 28%, 33%, and 10%, respectively, would not transfuse patients in an attempt to prevent sickle cell exacerbations, while 17%, 49%, 36%, and 51%, respectively, would transfuse to a hemoglobin concentration of 10 g·dl-1. The tendencies to administer preoperative intravenous fluid and to transfuse blood increased with disease severity and procedure invasiveness (P < 0.001). Although 89% felt comfortable managing patients with sickle cell disease, 73% thought an advisory statement on optimal perioperative management was needed. Conclusions: There is a wide variation in the management of children with sickle cell disease. Clinicians differentiate management based on disease severity and procedure type.
Original language | English (US) |
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Pages (from-to) | 43-49 |
Number of pages | 7 |
Journal | Paediatric anaesthesia |
Volume | 21 |
Issue number | 1 |
DOIs | |
State | Published - Jan 2011 |
Externally published | Yes |
Keywords
- acute chest syndrome
- anesthesia
- hemoglobinopathy
- pain crisis
- sickle cell disease
- surgery
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Anesthesiology and Pain Medicine