A survey of perioperative management of sickle cell disease in North America

Paul G. Firth, Kristen N. McMillan, Charles M. Haberkern, Myron Yaster, Michael A. Bender, Salvatore R. Goodwin

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)43-49
Number of pages7
JournalPaediatric Anaesthesia
Volume21
Issue number1
DOIs
StatePublished - Jan 2011

Fingerprint

Sickle Cell Anemia
North America
Surveys and Questionnaires
Practice Management
Acute Disease
Hemoglobins

Keywords

  • acute chest syndrome
  • anesthesia
  • hemoglobinopathy
  • pain crisis
  • sickle cell disease
  • surgery

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Firth, P. G., McMillan, K. N., Haberkern, C. M., Yaster, M., Bender, M. A., & Goodwin, S. R. (2011). A survey of perioperative management of sickle cell disease in North America. Paediatric Anaesthesia, 21(1), 43-49. https://doi.org/10.1111/j.1460-9592.2010.03415.x

A survey of perioperative management of sickle cell disease in North America. / Firth, Paul G.; McMillan, Kristen N.; Haberkern, Charles M.; Yaster, Myron; Bender, Michael A.; Goodwin, Salvatore R.

In: Paediatric Anaesthesia, Vol. 21, No. 1, 01.2011, p. 43-49.

Research output: Contribution to journalArticle

Firth, PG, McMillan, KN, Haberkern, CM, Yaster, M, Bender, MA & Goodwin, SR 2011, 'A survey of perioperative management of sickle cell disease in North America', Paediatric Anaesthesia, vol. 21, no. 1, pp. 43-49. https://doi.org/10.1111/j.1460-9592.2010.03415.x
Firth, Paul G. ; McMillan, Kristen N. ; Haberkern, Charles M. ; Yaster, Myron ; Bender, Michael A. ; Goodwin, Salvatore R. / A survey of perioperative management of sickle cell disease in North America. In: Paediatric Anaesthesia. 2011 ; Vol. 21, No. 1. pp. 43-49.
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