Abstract
A 37-year-old man with β-thalassemia intermedia (βTI), a rare disease caused by partial or complete deficiency of β-globin chain synthesis, fell into a hemolytic crisis. Severe anemia persisted despite frequent transfusions. Therefore, he was scheduled for splenectomy to alleviate the anemia. The preoperative laboratory data showed marked anemia and liver dysfunction. Echocardiography revealed hyperkinetic left ventricular motion and increased cardiac index (CI), indicating a compensatory hyperdynamic circulation induced by persistent, severe anemia. Our strategy during general anesthesia was to keep the hyperkinetic cardiovascular system steady. Hence, the hemodynamic parameters including the CI were measured using a Swan-Ganz catheter, and other physiological parameters were monitored perioperatively. Anesthesia was maintained with balanced anesthesia: isoflurane at low concentrations and fentanyl to avoid cardiovascular depression. Throughout the operation, vital signs were kept stable and the lactate/pyruvate ratio was unchanged, indicating that anaerobic metabolism did not increase. We report successful anesthetic management with attention to hemodynamic changes in a patient with βTI.
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Kitoh, T., Tanaka, S., Ono, K. et al. Anesthetic management of a patient with β-thalassemia intermedia undergoing splenectomy: a case report. J Anesth 19, 252–256 (2005). https://doi.org/10.1007/s00540-005-0328-y
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DOI: https://doi.org/10.1007/s00540-005-0328-y