Subarachnoid block in an eight-month old infant with glucose-6-phosphate dehydrogenase deficiency

Abstract

Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is a clinical condition characterized by red blood cell enzymatic defect resulting in  haemolysis following exposure to oxidative stress from medications and infections. Some of the drugs used in anaesthesia and peri-operative pain management may also induce haemolysis in individuals who are G6PD deficient. In this report, an eight-month-old boy with G6PD deficiency who had bilateral herniotomy under spinal anaesthesia without untoward events is described. Intraoperative and postoperative courses were uneventful as there were no haemolytic complications, malignant hyperthermia nor methaemoglobinaemia. The focus of anaesthetic management in this child was avoiding drugs which may cause haemolysis in G6PD deficiency, reducing surgical stress with adequate analgesia, and adequate preparations to manage haemolysis should it occur. Therefore, it is recommended that subarachnoid block with heavy bupivacaine can be performed safely, particularly for individuals with G6PD deficiency in place of general anaesthesia.

Keywords: Glucose-6-Phosphate dehydrogenase Deficiency, haemolysis, infancy, subarachnoid block