Derkay C S, Bray G, Milmoe G J, Grundfast K M
Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk.
South Med J. 1991 Feb;84(2):205-8. doi: 10.1097/00007611-199102000-00013.
The pediatric patient with sickle cell disease risks having a vasoocclusive episode during adenotonsillectomy under general anesthesia. With proper patient selection and appropriate perioperative management, adenotonsillectomy can be accomplished safely in children with sickle cell disease. We review the management of 10 children with sickle hemoglobinopathies who had adenotonsillectomy. Indications for surgery were recurrent streptococcal infections in four and obstructive sleep apnea in six of these children. No complications resulted from any of these procedures, and the mean length of postoperative hospitalization was 2.4 days. The principal feature of preoperative management was the transfusion of red blood cells to suppress the patient's endogenous erythropoiesis and to reduce the concentration of sickle cell hemoglobin to less than 30%. Though a prospective, multi-institutional clinical trial will ultimately be required to settle the issue of the safest preoperative management of children with sickle cell disease, balancing the risks of transfusion-related complications against anesthesia-related complications, our experience supports the operative safety of hypertransfusion therapy in children with sickle cell disease.
患有镰状细胞病的儿科患者在全身麻醉下行腺样体扁桃体切除术中存在血管闭塞性发作的风险。通过适当的患者选择和合适的围手术期管理，腺样体扁桃体切除术可在患有镰状细胞病的儿童中安全完成。我们回顾了10例患有镰状血红蛋白病且接受了腺样体扁桃体切除术的儿童的治疗情况。这些儿童中，4例的手术指征为复发性链球菌感染，6例为阻塞性睡眠呼吸暂停。这些手术均未导致并发症，术后平均住院时间为2.4天。术前管理的主要特点是输注红细胞以抑制患者的内源性红细胞生成，并将镰状细胞血红蛋白浓度降至30%以下。尽管最终需要一项前瞻性、多机构的临床试验来解决镰状细胞病患儿最安全的术前管理问题，权衡输血相关并发症与麻醉相关并发症的风险，但我们的经验支持对镰状细胞病患儿进行换血疗法的手术安全性。
