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///2015 Abstract Details
2015 Abstract Details2019-08-02T16:54:43-05:00

Retrospective Review of the Anesthetic Management of Parturients with Sickle Cell Disease with Case-matched Controls

Abstract Number: T-04
Abstract Type: Original Research

Annette E Martini MD, MS1 ; Jillian Stariha BS2; Paloma Toledo MD, MPH3; Priscilla Hensel MD, MS4; Heather C Nixon MD5

Background: Sickle cell disease (SCD) is the most common inherited disease worldwide. The disease manifests as chronic anemia, multi-organ damage, and painful vaso-occlusive crises. As care and management of SCD has improved, life expectancy for patients with SCD has increased and patients are no longer being counseled to avoid pregnancy. There is limited literature regarding the anesthetic management of parturients with SCD. Our goal is to provide a framework for other anesthesia providers to address the concerns regarding analgesic and anesthetic management of parturients with SCD.

Methods: Hospital billing database search was used to identify parturients with SCD who delivered between November 2008 and 2014. For each found, two matches were identified using anesthesia billing records with preference for approximate date of service, mode of delivery, and similar BMI. For each record, the following was extracted: patient demographics, medical history, gestational history, analgesic history, peripartum course, anesthetic techniques during peripartum period, peripartum analgesic requirements, and complications of peripartum anesthetic interventions. Odds ratios with 95% confidence intervals adjusted for mode of delivery were calculated.

Results: 39 pregnancies involving parturients with SCD were identified, 26 vaginal and 13 cesarean deliveries. 76% of SCD patients received narcotics during labor prior to epidural placement versus 22% of controls. SCD patients received epidural catheter placement when less dilated, median of 2cm vs. 4cm at time of placement, and had longer duration of use, 76% vs. 40% for >8hrs. Increases in rate of epidural infusion or manual rebolus of the epidural catheter were required by 41% of SCD parturients vs. 17% of controls. Odds ratios with 95% confidence intervals are shown in Table 1.

Conclusion: This unique dataset assessing the anesthetic needs of parturients with SCD is small and therefore may be underpowered to detect statistical significance. Trends toward early epidural catheter usage, need for an increase in epidural infusion rate/manual rebolus, and narcotic usage prior to epidural catheter placement suggest parturients with SCD are less tolerant of labor pain and have higher requirements for analgesia during the peripartum period. Our results confirm increased need for transfusion and increased rate of preeclampsia in SCD patients, factors of concern for anesthesiologists.

SOAP 2015