Hello
I have an 1,5 year old patient with G6PD defiency and surgeons are planning to operate him on wednesday.
Have you ever had a patient like that ? ???How do you manage his anaesthesia if you were me? :o
Can you suggest useful links? Thank you in advance..........
Don't give dipyrone, antipiretic & analgetic, in PostOp ;D
Interesting case. Along with the prior advice from newbi, here is what I would do.
First if you are not in a major medical center with a childrens hospital I would consider sending the pt to one. It's not that you could do the anesthetic successfully or the operation, but the patient may experience post-op complications that a smaller facility may not be experienced to handle.
Having said that, is there any way you could give the pt some IV antioxidents pre-op? Perhaps via a vitiam infusion? I don't recall off hand which to recomend, pharmacy should know. Next best possibility is to transfuse pt with PRBC as much as possible pre-op. This way at least the new PRBCs would have the ability to transport oxygen and not run the risk of lysing and hopefully make up some of the loss of RBCs from the stress of surgery. I would also consult with the surgeon about the possibility of using a steroid intra-op to help decrease the stress response.
For the anesthetic I would use a high narcotic technique ( sufenta/remifentinal), cisatracurium and desflurane.
Depending on the surgery a foly catheter maybe helpful to the extent that any hemolysis may show up in the urine color change. SpO2 will be first sign of RBC disfunction and lysis. Also urin clearing will help determine that the lysing has stoped. In addition urine output will help guage any effect of lysing on GFR with decreased urine output...might be nice to know so other actions can be initiated.
Hope this helps. post the outcome.