Spinal versus general anesthesia for Cesarean section in patients with sickle cell anemia / 대한마취과학회지

BACKGROUND: Sickle cell anemia (SCA) increases the rate of maternal and fetal complications. This pilot study was designed to compare the maternal and fetal outcomes of spinal versus general anesthesia (GA) for parturients with SCA undergoing cesarean delivery. METHODS: Forty parturients with known SCA scheduled for elective Cesarean delivery were randomized into spinal anesthesia (n = 20) and GA groups (n = 20). Perioperative hemodynamic parameters were recorded. Postpartum complications were followed up. Opioid consumption was calculated. Blood loss during surgery and the number of patients who received intraoperative or postpartum blood transfusion were recorded. Patient satisfaction with the type of anesthesia was assessed. The Apgar score at 1 and 5 min, neonatal admission to the intensive care unit, and mortality were also recorded. RESULTS: Blood loss was significantly higher in the GA than spinal group (P = 0.01). However, the number of patients who received an intraoperative or postpartum blood transfusion was statistically insignificant. Significantly more patients developed intraoperative hypotension and bradycardia in the spinal than GA group. Opioid use during the first 24 h was significantly higher in the GA than spinal group (P < 0.0001). More patients had vaso-occlusive crisis in the GA than spinal group without statistical significance (P = 0.4). There was one case of acute chest syndrome in the GA group. No significant differences were observed in postoperative nausea and/or vomiting, patient satisfaction, or hospital length of stay. Neonatal Apgar scores were significantly better in the spinal than GA group at 1 and 5 min (P = 0.006 and P = 0.009, respectively). Neonatal intensive care admission was not significantly different between the two groups, and there was no neonatal mortality. CONCLUSIONS: Spinal anesthesia may have advantages over GA in parturients with SCA undergoing Cesarean delivery.

Early detection of factor VIII inhibitors in hemophilia a patients with different treatment modalities

Hemophilia care in underdeveloped and developing countries is extremely inadequate and in some instances, completely absent. Persons with hemophilia battle the complications of both the disease and its treatment. One of the most serious of these problems is the development of the inhibitors. The development of the inhibitors influences their quality of life. This work was designed to: 1- elucidate the inhibitors status 2-to study the relation of factor VIII inhibitors and modes of therapy and duration of treatment 3- to clarify the cause of bleeding, is it related to insufficient treatment or development of inhibitors 4- to study the effect of the severity of hemophilia in the frequency of factor VIII inhibitors and their correlation with factor VIII level. The study included 63 hemophilic patients under different treatment modalities and were classified to four groups according to the types of treatment; they were group [I] included [7] patients with no previous anti hemophilic treatment and were considered as a control group, group [II] included [12] patients who were on treatment with fresh frozen plasma, group [III] consists of [16] patients who were under treatment with cryoprecipitate and group [IV] was [28] patients who were under treatment with concentrated factor VIII.To all groups of patients complete blood count, prothrombin time and prothrombin concentration, activated partial thromboplastin time, factor IX, von willebrand factor, factor VIII levels and factor VIII inhibitor levels were performed. Development of inhibitors was obvious in severe hemophilic patients especially in those who were receiving on demand factor VIII concentrate therapy