ISSN 2564-7784 | E-ISSN 2564-7040
1 Özel Sanko Üniversitesi, Anesteziyoloji ve Reanimasyon, Gaziantep, Turkey  
2 Adana Aşkın Tüfekçi Devlet Hastanesi, Dahiliye, Adana, Turkey  
Eur J Ther ; : -

Abstract

Hereditary spherocytosis (HS) is a type of hemolytic anemia. Anesthetic management of any  surgery with HS requires close monitoring of hypothermia, hypoxia, acidosis and  postoperative pain. We report a case of a14-year old male HS patient scheduled for laparoscopic cholecystectomy. He was operated for splenectomy 5 years ago. Hemoglobin (Hb) 11.5g/dl, Platelets 297K/ml, total bilirubin 4.50mg/dl with direct bilirubin 0.41mg/dl. In peripheral blood smear (PBS) spherocytosis percentage was 19% before surgery. He was premedicated with midazolam. After induction with propofol and fentanyl and atracurium anesthesia was maintained with air,O2 and Total Intra Venous Anesthesia (TIVA) with propofol and remifentanil. Electrocardiography (ECG), non-invasive blood pressure (NIBP), peripheral oxygen saturation, end-tidal carbondioxide (EtCO2) were monitored. We used airwarmer blanket. Intraoperatively arterial blood gas (ABG) values were evaluated as PH 7.37, PCO2 38.1 mmHg, PO2 177 mmHg, Hb 11.5 g/dl glucose 109mg/dl. Also intraoperatively PBS repeated and spherocytes percentage was 11%. In Post-Anesthesia Care Unit (PACU), ABG was as pH 7.36, PCO2 37.4 mmHg, PO2 210 mmHg, Hb 11.4 g/dl. PBS was repeated next day and spherocytes percentage was 16%. Multimodal analgesia was provided with tramadol, paracetamol and local infiltration of the surgical site. Postoperatively paracetamol infusion was given three times a day for pain control. Intraoperatively spherocytes percentage was less than the preoperative PBS (11%/19%). We consider that TIVA decreased spherocytes due to appropriate anesthetic management, ABG stabilisation, normothermia each alone or together. Next day, percentage was increased (16%) but stil remained under the first PBS. We consider this is due to good pain control and well- balanced hydration. In conclusion, TIVA provided a safe anesthetic management.

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