Hypertension perioperative splenectomy in thalassemic children.

We retrospectively studied the intraoperative hemodynamic changes in 100 thalassemic children undergoing general anesthesia for elective splenectomy. They were divided into 2 groups owing to the postoperative hemodynamic response. Eighty-four patients who had an unremarkable postoperative course were group 1, while 16 patients who developed immediate postoperative hypertension were group 2. There were no differences between the groups regarding age, body weight, sex, anesthetic time and operation time, except for the preoperative hematocrits of group 1 patients were slightly but significantly higher. Both groups similarly showed significant increase of the systolic as well as diastolic blood pressure throughout the anesthetic course. The heart rate was significantly increased at the beginning but declined to normal toward the end of the operation. Although none of the patients died postoperatively, all of group 2 patients needed aggressive treatment with diuretic and antihypertensive drugs. Despite the proper management, 3 of 16 patients developed convulsion and one of them had persistent neurological deficit. Since intraoperative and postoperative hypertension which commonly occur in these patients may lead to more serious neurological complications, the authors suggest that careful hemodynamic monitoring must be considered for all thalassemic children undergoing general anesthesia for splenectomy.