Abstract
Purpose: Currently, there is no consensus regarding the choice of anesthetic technique for parturients with sickle cell disease (SCD). The aim of the study was to determine the impact of the anesthetic technique on the occurrence of postnatal sickling complications.
Methods: We reviewed the charts of all pregnant women with SCD who had given birth in our institution between January 2002 and January 2007. Data related to pregnancy and anesthetic management and complications related, or unrelated, to SCD were recorded. Full blood count and lactate dehydrogenase values were recorded on the day of delivery. Risk factors for postnatal sickling complications were evaluated using a logistic regression analysis to estimate odds ratios (OR) and their 95% confidence intervals (95% CI).
Results: Fourteen of the 55 women (24%) experienced at least one postnatal sickling complication. Women who developed postnatal sickling complications were found to have a higher leukocyte count (17.0±6.1×109·L−1vs 12.8±4.4×109·L−1,P=0.008) and a lower hemoglobin level (7.8±1.1vs 8.9±1.0 g.dL−1,P=0.002). General anesthesia (OR=16.0; 95% CI, 1.6 to 165.6) and a leukocyte count ⩾15×109·L−1 (OR=8.4; 95% CI, 1.6 to 44.5) were identified as risk factors. Neuraxial anesthesia and use of ephedrine were not identified as risk factors. There were no deaths.
Conclusion: Our study suggests that general anesthesia could be associated with postnatal sickling complications, even when the severity of illness was taken into account.
Résumé
Objectif: Il n’y a actuellement pas de consensus concernant le choix d’une technique anesthésique pour les parturientes souffrant d’anémie falciforme. L’objectif de cette étude était de déterminer l’impact de la technique anesthésique choisie sur l’incidence des complications liées à la falciformation postnatale.
Méthode: Nous avons passé en revue les dossiers de toutes les femmes enceintes souffrant d’anémie falciforme ayant accouché dans notre centre entre janvier 2002 et janvier 2007. Les données relatives à la grossesse, à la prise en charge anesthésique et aux complications associées ou non à l’anémie falciforme ont été enregistrées. Les valeurs de la formule sanguine et de lacticodéshydrogénase ont été enregistrées le jour de l’accouchement. Les facteurs de risque concernant des complications liées à la falciformation postnatale ont été évalués sur la base d’une analyse de régression logistique à des rapports de cotes estimés (RC) et à leurs intervalles de confiance 95% (IC à 95%).
Résultats: Quatorze des 55 parturientes (24%) ont montré au moins une complication liée à la falciformation postnatale. Nous avons découvert que les femmes ayant développé des complications liées à la falciformation postnatale avaient une numération des globules blancs plus élevée (17,0±6,1×109·L−1vs 12,8±4,4×109·L−1,P=0,008) et un niveau d’hémoglobine plus bas (7,8±1,1vs 8,9±1,0 g.dL−1,P=0,002). Une anesthésie générale (RC=16,0; IC à 95%, 1,6 à 165,6) et une numération des globules blancs ⩾15×109·L−1 (RC=8,4; IC à 95%, 1,6 à 44,5) ont été identifiés comme facteurs de risque. Une anesthésie neuraxiale et l’administration d’éphédrine n’ont pas été identifiés en tant que facteurs de risque. Il n’y a pas eu de décès.
Conclusion: Notre étude suggère que l’anesthésie générale pourrait être associée à des complications liées à la falciformation postnatale et ce, même lorsque la gravité de la maladie a été prise en compte.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Steinberg MH. Management of sickle cell disease. N Engl J Med 1999; 340: 1021–30.
National Institutes of Health, National Heart, Lung, and Blood Institute, and Division of Blood Diseases and resources. The Management of Sickle Cell Disease, 4th ed. Bethesda: NIH Publication No 02-2117; 2002.
Stuart MJ, Nagel RL. Sickle-cell disease. Lancet 2004;364: 1343–60.
Howard RJ, Tuck SM, Pearson TC. Pregnancy in sickle cell disease in the UK: results of a multicentre survey of the effect of prophylactic blood transfusion on maternal and fetal outcome. Br J Obstet Gynaecol 1995; 102: 947–51.
Smith JA, Espeland M, Bellevue R, Bonds D, Brown AK, Koshy M. Pregnancy in sickle cell disease: experience of the Cooperative Study of Sickle Cell Disease. Obstet Gynecol 1996; 87: 199–204.
Leborgne-Samuel Y, Janky E, Venditelli F, et al. Drépanocytose et grossesse: revue de 68 observations en Guadeloupe. J Gynecol Obstet Biol Reprod (Paris) 2000; 29: 86–93.
Serjeant GR, Loy LL, Crowther M, Hambleton IR, Thame M. Outcome of pregnancy in homozygous sickle cell disease. Obstet Gynecol 2004; 103: 1278–85.
Koshy M, Weiner SJ, Miller ST, et al. Surgery and anesthesia in sickle cell disease. Cooperative Study of Sickle Cell Diseases. Blood 1995; 86: 3676–84.
American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology 2007; 106: 843–63.
Esseltine DW, Baxter MR, Bevan JC. Sickle cell states and the anaesthetist. Can J Anaesth 1988; 35: 385–403.
Danzer BI, Birnbach DJ, Thys DM. Anesthesia for the parturient with sickle cell disease. J Clin Anesth 1996; 8: 598–602.
Firth PG, Head CA. Sickle cell disease and anesthesia. Anesthesiology 2004; 101: 766–85.
Firth PG. Anaesthesia for peculiar cells. A century of sickle cell disease. Br J Anaesth 2005; 95: 287–99.
Feinstein AR, Pritchett JA, Schimpff CR. The epidemiology of cancer therapy. IV. The extraction of data from medical records. Arch Intern Med 1969; 123:571–90.
Prengler M, Pavlakis SG, Prohovnik I, Adams RJ. Sickle cell disease: the neurological complications. Ann Neurol 2002; 51: 543–52.
Jackson R, Reid JA, Thorburn J. Volume preloading is not essential to prevent spinal-induced hypotension at caesarean section. Br J Anaesth 1995; 75: 262–5.
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections.In: Olmsted RN (Ed). APIC Infection Control and Applied Epidemiology: Principles and Practice. St. Louis: Mosby; 1996: A-1–A-20.
Koshy M, Burd L, Wallace D, Moawad A, Baron J. Prophylactic red-cell transfusions in pregnant patients with sickle cell disease. A randomized cooperative study. N Engl J Med 1988; 319: 1447–52.
Eltzschig HK, Lieberman ES, Camann WR. Regional anesthesia and analgesia for labor and delivery. N Engl J Med 2003; 348: 319–32.
Zennadi R, Hines PC, De Castro LM, Cartron JP, Parise LV, Telen MJ. Epinephrine acts through erythroid signaling pathways to activate sickle cell adhesion to endothelium via LW-alphavbeta3 interactions. Blood 2004; 104: 3774–81.
Platt OS, Brambilla DJ, Rosse WF, et al. Mortality in sickle cell disease. Life expectancy and risk factors for early death. N Engl J Med 1994; 330: 1639–44.
Platt OS, Thorington BD, Brambilla DJ, et al. Pain in sickle cell disease. Rates and risk factors. N Engl J Med 1991; 325: 11–6.
Maitre B, Habibi A, Roudot-Thoraval F, et al. Acute chest syndrome in adults with sickle cell disease. Therapeutic approach, outcome, and results of BAL in a monocentric series of 107 episodes. Chest 2000;117: 1386–92.
Litos M, Sarris I, Bewley S, Seed P, Okpala I, Oteng-Ntim E. White blood cell count as a predictor of the severity of sickle cell disease during pregnancy. Eur J Obstet Gynecol Reprod Biol 2007; 133: 169–72.
Kato GJ, McGowan V, Machado RF, et al. Lactate dehydrogenase as a biomarker of hemolysis-associated nitric oxide resistance, priapism, leg ulceration, pulmonary hypertension, and death in patients with sickle cell disease. Blood 2006; 107: 2279–85.
Author information
Authors and Affiliations
Corresponding author
Additional information
Support was provided solely from institutional and/or departmental sources.
Conflict of interest: None declared.
Rights and permissions
About this article
Cite this article
Camous, J., N’da, A., Etienne-Julan, M. et al. Anesthetic management of pregnant women with sickle cell disease — effect on postnatal sickling complications. Can J Anesth 55, 276–283 (2008). https://doi.org/10.1007/BF03017204
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03017204