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- Title
Children with sickle cell disease: acute complications, acute pain and perioperative management.
- Authors
Akrimi, S.; Simiyu, V.; Nchimba, L.; Ngongola, A.
- Abstract
Sickle Cell Disease (SCD) is a haemoglobinopathy with multisystem complications. Anaesthetists are frequently involved in peri-operative management, managing acute complications, particularly those requiring critical care, and providing expertise in managing acute pain. Common acute complications are vaso-occlusive episodes including splenic complications, sepsis, acute chest syndrome and stroke, priorities in management of which are adequate oxygenation and hydration, blood transfusion to improve oxygen delivery and reduce the percentage of sickle-haemoglobin, and multimodal analgesia. In low and middle-income countries, children are most commonly seen by healthcare professionals when presenting acutely, therefore chronic management and risk reduction must also be considered at this point. Peri-operatively, priorities for care are optimisation of oxygen delivery and blood flow to the tissues including avoidance of hypoxaemia, hypercarbia, hypotension, hypothermia and acid-base disorders, ensuring adequate pain management, and promoting recovery. Care should be in settings with specialist expertise in SCD from paediatric, anaesthetic, surgical and critical care teams. Focus on development of systems for surgical care for SCD children in prevalent regions, including rapid access to blood products, developing experience in rural centres, referral pathways to regional specialist hubs, and local guideline and research development, is required to reduce the high childhood mortality from SCD seen globally.
- Subjects
SICKLE cell anemia diagnosis; PERIOPERATIVE care; PREOPERATIVE care; HEMOGLOBINS; STROKE; IMMUNIZATION; INTRAOPERATIVE care; PEDIATRICS; SPLEEN diseases; SEPSIS; DIAGNOSTIC imaging; CRITICAL care medicine; SICKLE cell anemia; PAIN management; ACUTE chest syndrome; DISEASE complications
- Publication
Update in Anaesthesia, 2023, Vol 37, p28
- ISSN
1353-4882
- Publication type
Article
- DOI
10.1029/WFSA-D-20-00010