Open heart surgery in patients with sickle cell hemoglobinopathy.

BACKGROUND: In patients with sickle cell trait or disease, reduced life expectancy and a tendency for complications are believed to negatively affect likelihood of survival after open heart surgery. The aim of this study was to review retrospectively the perioperative results of patients undergoing cardiac surgery at our institution. METHODS AND RESULTS: Between January 1995 and December 2006, 47 patients with either sickle cell disease or sickle cell trait underwent open heart surgery at our institution. The average age of the 29 male and 18 female patients was 20 years. Patient outcomes were analyzed through the use of the institutional database. Clinical and echocardiographic follow-up was complete in all patients except 3, with a mean follow-up period of 46 months. Current status could be confirmed in 32 patients. The most common operations included the treatment of congenital and valvular heart diseases. There were no coronary artery bypass grafting procedures. Average weight of the patients was 45 kg. Exchange transfusion was performed both preoperatively and during surgery. Mean preoperative hemoglobin S concentration was 30.4 + or - 3.2% and decreased to 8.1 + or - 2.6% while on pump. Average on-pump hematocrit value was 25.4 + or - 3.7%; in the postoperative period, it increased to 32.7 + or - 4.9%. Mean cardiopulmonary bypass and cross-clamp times were 95 and 69 minutes, respectively. None of the patients had sickling crisis or acidosis. Postoperative complications included exploration for hemorrhage in 3 patients (6.4%), stroke in 2 patients (4.3%), renal failure in 2 patients (4.3%), and prolonged ventilation in 1 patient (2.1%). Average hospital stay was 8.3 days (range, 4 to 27 days). Early in-hospital death occurred in 1 patient (2.1%); currently, 31 patients (66%) remain alive and free of cardiac symptoms. CONCLUSIONS: Heart valve surgery and surgery for congenital heart diseases can be performed safely in patients with sickle cell disease or sickle cell trait with acceptable outcome and survival rates.

Intrapartum temperature changes following the intravenous crystalloid bolus for epidural analgesia.

OBJECTIVE: To assess the effect of the intravenous crystalloid bolus given before epidural analgesia on maternal temperature during labour. Multiple studies have demonstrated a hyperthermic trend in parturient women receiving epidural analgesia. This temperature rise may be affected by the pre-epidural intravenous crystalloid bolus. METHODS: Intrapartum oral temperatures were recorded in 40 singleton parturient women immediately before and after an intravenous bolus of Ringer's lactate solution (1L at room temperature [21 degrees C]) and at one hour after standardized insertion of an epidural catheter for analgesia. Exclusion criteria included antibiotic administration, chorioamnionitis, and initial maternal temperature above 37.5 degrees C. Group means were compared using the 2-tailed paired Student t test. RESULTS: There was no significant trend towards a decrease in maternal temperature after the crystalloid bolus (mean change -0.07 degree C, P = 0.33). Similarly, there was no initial trend towards an increased maternal temperature after epidural insertion (mean change + 0.02 degrees C, P > 0.7). Separate analyses using parity, body mass index, and bolus duration as covariates showed that these variables did not affect maternal temperature changes (P > or = 0.2). CONCLUSION: Our study indicates that intravenous infusion of a crystalloid bolus at room temperature before induction of epidural analgesia does not significantly decrease parturient temperature.