The patient with a sickle hemoglobinopathy who presents for emergency surgery represents a challenge in the perioperative period to the anesthesia team. Many questions have to be answered: What is the correct diagnosis? Is this merely a crisis? Is there time to evaluate the laboratory values in order to make a decision regarding exchange or simple transfusion? Is the obstetrical patient in labor also having a crisis? Is the trauma patient anemic because of bleeding or a crisis? The anesthesiologist who provides care in this setting must have an adequate knowledge of the pathophysiology of the sickle hemoglobinopathies. A thorough and detailed history and physical examination will provide clues to the diagnosis. Time, laboratory information, and the patient's clinical condition will help in decision making. A team approach is mandatory for adequate management of the patient, and should include the anesthesiologist, surgeon, hematologist, pediatrician, obstetrician, and internist. The choice of the anesthetic also will be dictated by the patient's clinical condition. Finally, administration of a safe anesthetic in a warm environment with the caveat to avoid acidosis, hypoxia, and dehydration in the perioperative period will reduce morbidity and mortality.
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine