Anesthesia and surgery in pediatric patients with low hemoglobin values

A low preoperative hemoglobin (Hb) concentration creates a dilemma for the anesthetist to proceed or not. The authors prospectively studied the perioperative morbidity of 200 healthy infants and children (age range 3 mon-5 years) with preoperative Hb values > or = 7 g/dl, undergoing cleft lip and palate surgery under general anesthesia. The patients were later categorized according to preoperative Hb level group A: Hb 7-10 g/dl and group B: Hb > 10 g/dl and the results were compared. One or more episodes of hypoxemia (SpO2 < 91%) were recorded in 8 patients in group A and 6 in group B during airway management. All patients had stable cardiovascular parameters except for transient bradycardia during desaturations. Recovery was similar and rapid. There were no differences in perioperative morbidity between the two groups. However, the safety of general anesthesia in infants and children with difficult airways is questionable when the oxygen reserve is reduced in anemia.