Sickle Cell Disease and Perioperative Considerations: Review and Retrospective Report

Purpose: To review the current literature on sickle cell disease (SCD) and patient management in the perioperative setting and to retrospectively evaluate the treatment and complications of oral and maxillofacial surgical patients with SCD treated in the Regional Medical Center at Memphis. Materials and Methods: A literature review was performed, with the main search criteria of SCD, anesthesia, and oral and maxillofacial surgery. In addition, a retrospective record analysis was performed of patients with SCD seen at the Regional Medical Center over 9 years. Criteria recorded included the procedure, type of anesthesia, use of intravenous fluids, thermoregulation (use of warm fluids and blankets covering the patient), supplemental oxygen, antibiotic prophylaxis, and postoperative complications. Results: In total, 33 clinic visits were reviewed, with 29 patients and 21 procedures performed. Patients were managed quite differently each time, with no consistent protocol. Intravenous fluids were used in only 9 of 21 procedures, supplemental oxygen was recorded for 11 of 21 patients, and preoperative antibiotics were given to 14 of 21 patients. A small sample and the lack of an established protocol did not provide significant statistics. Conclusion: Patients with SCD are at risk for various perioperative complications, and it is imperative that the surgeons be educated and prepared so they can effectively manage these patients. No significant complications were found through the outpatient treatment of patients with SCD in this analysis. It may be concluded that treating patients with SCD in the outpatient setting is not contraindicated and may be a safe alternative to inpatient treatment or no treatment at all. (C) 2013 American Association of Oral and Maxillofacial Surgeons