This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal

Preoperative Management and Postoperative Complications

David J. Halvorson, MD; Virgil McKie, MD; Kathleen McKie, MD; Philip E. Ashmore, MD; Edward S. Porubsky, MD

Arch Otolaryngol Head Neck Surg. 1997;123(7):689-692.

Abstract
Background
Patients with sickle cell disease are recognized as having a relatively higher risk for postoperative complications, including fever, atelectasis, pneumonia, or sickle cell vaso-occlusion.

Objective
To present a protocol for preoperative management of patients with sickle cell disease undergoing tonsillectomy, including the use of transfusions and intravenous hydration.

Design
Retrospective chart review.

Setting
Academic, tertiary care referral medical center.

Patients
Seventy-five patients with sickle cell disease who underwent tonsillectomy with or without adenoidectomy were included for review. Preoperative management was documented, and risk factors were assessed. Intraoperative management was reviewed, and postoperative complications were identified and compared with preoperative data and management.

Results
Preoperative management consisted of transfusions to a hemoglobin S ratio (hemoglobin S—total hemoglobin) less than 40% or a hemoglobin level greater than 100 g/L. Aggressive intravenous hydration of 1.5 times the maintenance fluid was given 24 hours before surgery. Increased complications were associated with a preoperative hemoglobin S ratio greater than 40% (P<.05) and an age younger than 4 years (P<.05). Operative time, technique, and blood loss were not statistically significant risk factors. The average length of hospitalization was 4.8 days.

Conclusions
Children with sickle cell disease presenting for elective tonsillectomy should be given a transfusion to a hemoglobin S ratio less than 40% in an attempt to reduce postoperative complications. Additional factors, such as age and presence of obstructive sleep apnea, only increase the potential risks.

Arch Otolaryngol Head Neck Surg. 1997;123:689-692

Author Affiliations
From the Departments of Surgery (Drs Halvorson, Ashmore, and Porubsky) and Pediatrics (Drs V. McKie and K. McKie), Division of Otolaryngology, Medical College of Georgia, Augusta. Dr Halvorson is currently with the Division of Otolaryngology, Department of Surgery, the University of Alabama at Birmingham.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Sleep-Related Hypoventilation/Hypoxemic Syndromes
Casey et al.
Chest 2007;131:1936-1948.
ABSTRACT | FULL TEXT