[Anesthesiological management in patients with sickle cell disease]

We report on the general anesthesia in the case of an orthopedic surgery conducted on two brothers with sickle cell anemia. After concerted planning with a pediatric hematologist concerning the perioperative management an exchange transfusion was conducted ambulatorily before surgery. The following anesthesia under continuous fluid infusion, warming and regular hemoglobin and temperature control could be conducted without problems. One of the boys was treated with two heterologous red cell packs after an unexpected hemoglobin drop intraoperatively. The postoperative course was uneventful, especially concerning sickle cell relevant complications. The case reports are intended to show up the pathogenesis of patient-relevant sickle cell crises and critically evaluate central points of anesthesiological management, especially the choice of preoperative transfusion.