Anesthetic management of pregnant women with sickle cell disease--effect on postnatal sickling complications

Abstract

Purpose: Currently, there is no consensus regarding the choice of anesthetic technique for parturients with sickle cell disease (SCD). The aim of the study was to determine the impact of the anesthetic technique on the occurrence of postnatal sickling complications.

Methods: We reviewed the charts of all pregnant women with SCD who had given birth in our institution between January 2002 and January 2007. Data related to pregnancy and anesthetic management and complications related, or unrelated, to SCD were recorded. Full blood count and lactate dehydrogenase values were recorded on the day of delivery. Risk factors for postnatal sickling complications were evaluated using a logistic regression analysis to estimate odds ratios (OR) and their 95% confidence intervals (95% CI).

Results: Fourteen of the 55 women (24%) experienced at least one postnatal sickling complication. Women who developed postnatal sickling complications were found to have a higher leukocyte count (17.0+/-6.1x10(9).L(-1) vs 12.8+/-4.4x10(9).L(-1), P=0.008) and a lower hemoglobin level (7.8+/-1.1 vs 8.9+/-1.0 g.dL(-1), P=0.002). General anesthesia (OR=16.0; 95% CI, 1.6 to 165.6) and a leukocyte count>or=15x10(9).L(-1) (OR=8.4; 95% CI, 1.6 to 44.5) were identified as risk factors. Neuraxial anesthesia and use of ephedrine were not identified as risk factors. There were no deaths.

Conclusion: Our study suggests that general anesthesia could be associated with postnatal sickling complications, even when the severity of illness was taken into account.