Anaesthetic Management of Homozygous Sickle Cell Patients at Niamey National Hospital, Niger

Abstract

Background: Sickle cell disease is a common comorbidity in patient presenting for surgical care in our hospitals. The aim of this study was to evaluate the outcome of anaesthetic management of sickle cell disease patients in our hospital.
Patients and method: A prospective audit was conducted for a period of 12 months, from 1st March 2015 to 29th February, 2016. Included were all homozygous sickle cell patients who underwent anaesthesia. The following variables were studied: age, sex, blood transfusion, hemoglobin level, ASA status, type of anaesthesia, pre-, intra- and post-operative management and outcome.
Results: Thirty (30) patients with homozygous sickle-cell disease were found among the 3882 patients who were operated on (0.77%). Mean age was 12 ± 8 years, with a range from 9 months to 36 years. More than half of the patients were female (53.3%) with a sex ratio of 1.14. Hemoglobin level was less than 7 g / dl in 23.33%. Only 6.67% of patients had hemoglobin level above 10 g / dl. Of the 30 patients, 93.34% were ASA II, 36.70% had preoperative transfusion, surgery was elective in 93.30% and emergent in 6.70%. The commonest surgical procedures were tonsillectomy in 26.66%. General anaesthesia was performed in 96.70% of patients, spinal anaesthesia in 3.30%. Intraoperative incidents occurred in 23.33%. Intraoperative transfusion was given to 43.30% of patients. Mortality rate was 10%.
Conclusion: Anaesthetic management of the sickle cell patient in our hospital is challenging due to lack of transfusion procedures and exchange transfusions.

Keywords: Sickle cell disease, anaesthesia, outcome, Niamey, Niger