European Journal of Anaesthesiology



Review
(RD) Surgery

Anaesthetic care for sickle cell disease


T. Frietsch a1c1, I. Ewen a1 and K. F. Waschke a1
a1 Department of Anesthesiology and Intensive Care, Faculty of Clinical Medicine Mannheim, Ruprecht-Karls-Universitat Heidelberg, D-68167 Mannheim, Germany

Article author query
frietsch t   [PubMed][Google Scholar] 
ewen i   [PubMed][Google Scholar] 
waschke kf   [PubMed][Google Scholar] 

Abstract

Despite the high frequency of sickle cell disease in Europe, the disease is poorly managed. Critical periods are the hospital stays during which the anaesthe-siologist plays an important role. Understanding the molecular basis of polymerization processes of haemoglobin S can help to avoid triggering a crisis. Differentiation of the various haemoglobin phenotypes helps to estimate the individual perioperative risk. Knowledge of the patient's history and the actual haemoglobin S level facilitates general anaesthesia, surgery and postoperative care. Damage to liver, spleen, eyes, bones, lung and central nervous system increases the perioperative risk. Preoperative preparation includes early admission, intravenous volume substitution, continuing pain therapy and prophylactic antibiotic medication. General anaesthesia seems to be better for patients with a high-risk profile rather than regional anaesthesia. Careful perioperative and postoperative monitoring should allow hypoxaemia, hypovolaemia, hypothermia, acidosis and overtrans-fusion to be avoided. Effective pain therapy includes a combination of opioids with peripherally acting analgesia.

(Published Online August 16 2006)
(Accepted October 2000)


Key Words: haemoglobinopathies; sickle cell anaemia; haemoglobin sc disease; haemoglobin C disease; thalassemia; anaesthesia; anaesthetic techniques; analgesia; transfusion.

Correspondence:
c1 Correspondence: T. Frietsch.