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[Anesthesia for a patient with severe aplastic anemia]
M Tanaka1, I Nishihara, H Mori
1Department of Anesthesiology, Osaka Medical College, Takatsuki.
Masui. the Japanese Journal of Anesthesiology
|July 1, 1996
Summary
This study details a challenging transurethral lithotomy in a patient with severe aplastic anemia. Despite aggressive treatment, persistent bleeding complications highlight the risks of surgery in such patients.
Area of Science:
- Anesthesiology
- Hematology
- Urology
Background:
- Severe aplastic anemia presents significant challenges for surgical procedures due to profound cytopenias.
- Transurethral lithotomy is indicated for pyelonephritis and urethral stones, requiring careful anesthetic and surgical management.
Observation:
- A 48-year-old female with severe aplastic anemia (anemia, leukopenia, thrombocytopenia) underwent transurethral lithotomy.
- Anesthesia was mask-based with midazolam, fentanyl, nitrous oxide, oxygen, and sevoflurane.
- The 40-minute procedure was hemodynamically stable without immediate complications.
Findings:
- Despite platelet transfusions, the patient experienced prolonged bleeding tendency.
- Postoperatively, macrohematuria persisted for approximately 3 weeks, requiring extensive blood product support.
- The patient received 100 units of platelets and 13 units of leukocyte-poor red blood cells.
Implications:
- This case underscores the critical need for meticulous perioperative management in patients with severe aplastic anemia undergoing urological procedures.
- Anesthetic techniques should prioritize hemodynamic stability and minimize bleeding risks.
- Further research into optimal management strategies for bleeding complications in these high-risk patients is warranted.