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[Case of laparoscopic cholecystectomy in a patient with glucose-6-dehydrogenase deficiency]
Rina Wada1, Hirofumi Hino, Yumi Ando
1Department of Anesthesiology, St. Marianna University School of Medicine, Kawasaki, Japan.
Insights
Anesthesia management for glucose-6-phosphate dehydrogenase (G6PD) deficiency patients requires avoiding oxidant stress. This study found that midazolam, vecuronium, nitrous oxide, and sevoflurane provided safe anesthesia, preventing hemolysis in a G6PD-deficient child.
Area of Science:
- Anesthesiology
- Clinical Pharmacology
- Genetics
Background:
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic disorder.
- Patients with G6PD deficiency are susceptible to acute hemolytic anemia.
- Hemolysis can be triggered by oxidant drugs, infections, and surgical stress.
Observation:
- A 5-year-old male with a history of hemolysis due to G6PD deficiency underwent laparoscopic cholecystectomy.
- The patient had experienced hemolysis with infections and fava bean ingestion (favism).
Findings:
- Anesthesia was induced using midazolam and vecuronium.
- Maintenance involved nitrous oxide in oxygen and sevoflurane.
- No hemolytic changes were observed during the perioperative period.
- This anesthetic drug combination proved safe for the G6PD-deficient patient.
Implications:
- Careful selection of anesthetic agents is crucial for G6PD-deficient patients.
- Avoiding oxidant stress during anesthesia is paramount.
- The study suggests specific anesthetic drugs can be safely used in G6PD deficiency.
Abstract:
We report management of anesthesia in a patient suffering from glucose-6-phosphate dehydrogenase (G6PD) deficiency, a condition that induces acute hemolysis when associated with surgical stress and infection, or following the application of oxidant drugs. A 5 year-old-male patient, suffering from G6PD deficiency was scheduled for laparoscopic cholecystectomy. The patient had exhibited signs of hemolysis during the course of various infections and after ingesting fava beans (favism). Anesthesia was induced with midazolam and vecuronium and maintained with nitrous oxide in oxygen and sevoflurane. There was no hemolytic change during the perioperative period. It was clear that this combination of drugs provided safe anesthesia for the G6PD patient in the present study. The most important considerations for patients with G6PD deficiency is firstly, the avoidance of oxidative stress, which can be caused by a variety of different conditions, and secondly, the use of anti-oxidative anesthetic drugs.