Question

which anesthesia contraindication of sickle cell trais

Answer 1

Answer:

The hazards of surgery in these patients are not always those which are attendant on conditions suggesting emergency surgery. . .The presence of the basic disease increases the hazard of surgery, and of course, of anesthesia.—In Anesthesiology, 1955.

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Answer 2

Explanation:

Sickle cell disease (SCD) is a group of inherited disorders of the beta-hemoglobin chain.

Normal hemoglobin has 3 different types of hemoglobin – hemoglobin A, A2, and F.

Hemoglobin S in sickle cell disease contains an abnormal beta globin chain encoded by a

substitution of valine for glutamic acid on chromosome 11. This is an autosomal recessive

disorder. Sickle cell disease refers to a specific genotype in which a person inherits one

copy of the HbS gene and another gene coding for a qualitatively or quantitatively abnormal

beta globin chain. Sickle cell anemia (HbSS) refers to patients who are homozygous for the

HbS gene, while heterozygous forms may pair HbS with genes coding for other types of

abnormal hemoglobin such as hemoglobin C, an autosomal recessive mutation which

substitutes lysine for glutamic acid. In addition, persons can inherit a combination of HbS

and β -thalassemia. The β-thalassemias represent an autosomal recessive disorder with

reduced production or absence of β-globin chains resulting in anemia. Other genotype pairs

include HbSD, HbSO-Arab and HbSE.

A well conducted general and/or regional anesthetic technique can be employed in the care

of a patient with SCD who has been preoperatively evaluated and prepared for surgery. The

choice of a general anesthetic requires maintaining hemodynamics and ventilation within

normally accepted ranges and optimizing the patient’s volume status and temperature.

Certain patients may require preoperative blood transfusion or hydration to prevent a

perioperative SCD crisis. Pain control is critical, especially in the post-operative period to

ensure sufficient respiratory effort to avoid acute chest syndrome. Of note, regional

anesthesia can provide redistribution of blood flow and increase capillary and venous oxygen

tension in blocked areas but concomitant compensatory vasoconstriction in non-blocked

areas may result in decreased venous oxygen tension. Therefore, regional anesthesia as

the only anesthetic must be used with caution because of the potential for regional hypoperfusion and venous stasis, which can precipitate sickling. In addition, an inadvertent

high level of block may compromise respiratory muscles leading to hypoxemia.

The Cooperative Study of Sickle Cell Disease found that SCD related complications after

surgery were more frequent in patients who received regional anesthesia compared with

those who received general anesthesia. A more recent randomized, controlled, multicenter

trial, The Transfusion Alternatives Preoperatively in Sickle Cell Disease (TAPS), reaffirmed

the need for preoperative transfusion prior to surgery to avoid life threatening complications

such as acute chest syndrome. A combined technique using regional anesthesia for

intraoperative and postoperative pain control and general anesthesia for surgery might be

the safest approach.

There are no absolute contraindications to sedation in persons with SCD; however, it

remains crucial to avoid situations which may trigger an event such as hypothermia,

inadequate oxygenation, hypoventilation, and/or inadequate sedation leading to pain and

vasoconstriction.

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