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

Abstract

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.

• Authors: Paul G Firth, Kristen N McMillan, Charles M Haberkern, Myron Yaster, Michael A Bender, Salvatore R Goodwin
• Journal: Paediatric anaesthesia (Paediatr Anaesth) Vol. 21 Issue 1 Pg. 43-9 (Jan 2011) ISSN: 1460-9592 [Electronic] France
• PMID: 20880153 (Publication Type: Journal Article)
• Copyright: © 2010 Blackwell Publishing Ltd.

Topics

• Anemia, Sickle Cell (therapy)
• Anesthesia
• Blood Transfusion
• Child
• Fluid Therapy
• Health Care Surveys
• Humans
• Intraoperative Care
• North America
• Perioperative Care
• Preoperative Care
• Referral and Consultation