Abstract
Fifteen patients, 13 male and two female, known to be carrying the sickle-cell gene (12 HbSS and 3 HbAS), who were undergoing operations requiring a bloodless field, were included in the study. Of the 12 with HbSS, seven had haemoglobin A, component of between 11 and 27%, three had fetal haemoglobin ranging from 5.7 to 29% and the remaining two had increased haemoglobin A2 concentrations suggesting a beta non-thalassaemia combination. All had a tourniquet applied to the appropriate limb and were given general anaesthesia with moderate hyperventilation throughout the procedure. The tourniquet inflation time was 61.7 ± 27.5 min. The mean PaO2 remained above 200 mmHg, mean PaCO2 was less than 37 mmHg, and pH ranged between 7.40 and 7.45. There were no clinically important changes in BP or ECG. All patients made uneventful recoveries and none developed sickle-cell crises. It is suggested that it is safe to use tourniquet in patients with sickle-cell disease provided optimum acid-base status and oxygenation are maintained throughout the procedure.
Résumé
Quinze patients dont 13 hommes et 2 femmes, connus porteurs du gène d’hématie falciforme (12 HbSS et 3 HbAS) ont été inclus dans l’étude. Ils subissaient des interventions nécessitant un champ exsangue. Parmi les 12 HbSS, sept avaient une HbA1 entre 11 et 27%, trois avaient une Hb foetale entre 5,7 et 29% et deux autres avaient une HbA2 accrue suggérant une combinaision β non thalassémique. Tous ont eu un garrot placé sur le membre approprié et ont eu une anesthésie générale avec une hyperventilation modérée pendant l’intervention. Le temps de garrot a été de 61,7 ± 27,5 min. La PaO2 moyenne est restée au-dessus de 200 mm de Hg, la PCO2 moyenne inférieure à 37 mmHg et le pH entre 7,40 et 7,45. Il n’y a pas eu de changement cliniquement important de la pression artérielle et de l’ECG. Tous les patients se sont réveillés sans problème, aucun n’a eu de crise d’hémolyse. On suggère qu’il est inoffensif d’utiliser un garrot en cas de thalassodrépanocytose pourvu que l’état acido-basique et l’oxygénation optimum soient maintenus pendant l’intervention.
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Adu-Gyamfi, Y., Sankarankutty, M. & Marwa, S. Use of a tourniquet in patients with sickle-cell disease. Can J Anaesth 40, 24–27 (1993). https://doi.org/10.1007/BF03009313
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DOI: https://doi.org/10.1007/BF03009313