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Does furosemide prevent hypertension during perioperative splenectomy in thalassemic children?
V Suwanchinda1, S Pirayavaraporn, B Yokubol
1Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Furosemide did not prevent hypertension in pediatric thalassemia patients undergoing splenectomy. While it helped stabilize hemodynamics post-anesthesia, its role in preventing neurological issues like convulsions requires further study.
Area of Science:
- Pediatric Anesthesiology
- Hematology
- Cardiovascular Physiology
Background:
- Splenectomy is common in children with thalassemia.
- Perioperative hemodynamic management is critical in these patients.
- Hypertension and neurological complications are potential risks.
Purpose of the Study:
- To compare hemodynamic changes in thalassemic children undergoing splenectomy with and without pre-operative furosemide.
- To evaluate the efficacy of furosemide in preventing perioperative hypertension and neurological abnormalities.
Main Methods:
- A comparative study involving 50 thalassemic children who underwent splenectomy under general anesthesia.
- One group (n=40) received intravenous furosemide (1 mg/kg) pre-operatively; a control group (n=10) did not.
- Hemodynamic variables (heart rate, blood pressure) were monitored during anesthesia and post-operatively.
Main Results:
- Both groups exhibited increased heart rate and blood pressure during anesthesia.
- The furosemide group showed hemodynamic variables returning toward normal post-anesthesia, unlike the control group.
- Postoperative hypertension (>130/90 mmHg) occurred in 20% of the furosemide group and 18% of the control group.
- No neurological symptoms were observed in the furosemide group, but 3 patients in the control group experienced convulsions.
Conclusions:
- Pre-operative furosemide does not prevent perioperative hypertension in thalassemic children undergoing splenectomy.
- Furosemide may have a role in preventing neurological complications, warranting further investigation.
Abstract:
Hemodynamic changes of 50 thalassemic children who had splenectomy under general anesthesia were compared to 40 identical patients who, in addition, received intravenous furosemide 1 mg/kg immediate preoperation. During the anesthetic process, both groups showed a significant increase of heart rate, systolic and diastolic blood pressure more than the preanesthetic values. Hemodynamic variables in the furosemide group declined toward normal range on termination of anesthesia, whereas, the other group's variables were still significantly higher than their control. During the first 24 hours postoperatively, 20 per cent of the furosemide group had blood pressure rising higher than 130/90 mmHg, while 18 per cent was observed in the other group. Antihypertensive drugs were given to reduce the blood pressure in both groups. None of the patients in the furosemide group demonstrated any abnormal neurological symptoms, but 3 out of 50 patients in the other group developed convulsion. We, therefore, conclude that circulatory volume reduction with furosemide does not prevent hypertension during perioperative splenectomy in thalassemic children. However, it's role in prevention of neurological abnormalities needs to be further investigated.