Guidelines on peri -operative management of patients with sickle cell disease: A consensus statement

Sickle cell disease is a multisystem disease characterised by chronic haemolytic anaemia, painful vaso-occlusive crises and acute and chronic end-organ damage. Peri-operative complications are higher for patients with sickle cell disease than for the general surgical population, but outcomes can be improved with careful peri-operative care and the involvement of specialist teams. Peri-operative complications may be sickle-related, transfusion-related, or related to surgery or anaesthesia.

So,these guidelines were developed to highlight advances in peri-operative care of patients with sickle cell disease; to provide anesthetists with a better understanding of sickle cell disease; and to make recommendations about the organisation of care for this complex group of patients.

Recommendations as given , have been summerised below.

• Clinical teams should work in partnership with patients and their families, and endeavour to make sure they are kept informed of clinical decisions relating to their care at all times.
• The lead clinician in the Department of Anaesthesia is responsible for making sure that there is local departmental guidance for the peri-operative management of patients with sickle cell disease, developed in partnership with the haematology team. The Department may wish to identify a specific lead for this role.
• All patients at risk of haemoglobinopathy should be screened for haemoglobinopathy before surgery but unnecessary repeat screening should be avoided.
• There should be a nominated lead haematologist (or for children, a lead paediatrician or paediatric haematologist) when a patient with sickle cell disease undergoes surgery. The nominated leads are responsible for deciding the peri-operative transfusion plan, with support of the specialist centre where relevant.
• Local governance arrangements should be in place so that the surgical team booking the patient for surgery communicates the sickle cell disease diagnosis at all stages of the patient pathway, and documents this clearly in the patient record so that the relevant teams are aware: haematology; anaesthesia; transfusion laboratory; waiting list co-ordinators; pre-assessment; and ward nursing staff.
• Patients with sickle cell disease presenting for elective surgery should be reviewed in a pre-assessment clinic, with input from the nominated lead haematologist (or for children a paediatrician/paediatric haematologist). The haematology team must be informed if a patient with sickle cell disease is admitted for emergency surgery.
• The acute pain team should be notified in advance if a patient with sickle cell disease is undergoing major surgery, particularly if the patient has a history of chronic pain.
• Patients with sickle cell disease should be scheduled early on the operating list to avoid prolonged starvation. Last minute cancellations for administrative reasons should be avoided, particularly if the patient has received a blood transfusion in preparation for surgery.
• Patients are at increased risk of sickle complications (acute chest syndrome, pain, acute renal insufficiency or stroke), sepsis and venous thromboembolism in the peri-operative period. The majority of complications occur postoperatively, and there should be a low threshold to admit patients to high dependency or intensive care.
• Patients require meticulous peri-operative care to avoid factors that may precipitate sickling: dehydration; hypoxia; acidosis; hypothermia; and pain. Routine surgery should be avoided if the patient is febrile or having a painful crisis.
• Pregnancy confers an increased risk for patients with sickle cell disease. Patients should be managed by a multidisciplinary team and be encouraged to give birth in hospitals able to manage high-risk pregnancies and complications of sickle cell disease.
• Patients should be managed according to standard COVID-19 care pathways, striking a careful balance between limiting hospital contact to minimise the risks of viral exposure and avoiding delays to essential treatments.

"This is the first anaesthetic-led multidisciplinary statement on peri-operative management of patients with sickle cell disease presenting for routine and emergency surgery in all hospital settings. It is the collaborative effort of sickle haematologists, transfusion medicine specialists, patient representatives, anaesthetists and surgeons. It draws together current best evidence for management of patients with sickle cell disease in the peri-operative period, particularly relating to blood transfusion, and prevention and management of complications."the team concluded.

For full article follow the link: https://doi.org/10.1111/anae.15349

Source: Anaesthesia