Fast-track cardiac anesthesia in patients with sickle cell abnormalities

We conducted a retrospective review of 10 patients with sickle cell trait ( SCT) and 30 patients (cohort control) without SCT undergoing first-time cor onary artery bypass graft surgery with cardiopulmonary bypass. Demographic, perioperative management, and outcome data were collected. Both groups wer e matched according to age, weight, duration of surgery, and preoperative h emoglobin (Hb) concentration Distribution of gender, medical conditions, ph armacological treatment, and preoperative left ventricular function were si milar between the groups. The comparisons were analyzed in respect to posto perative blood loss and transfusion rates, as well as duration of intubatio n, intensive care unit, and hospital length of stay (LOS). All patients und erwent fast-track cardiac anesthesia. A combination of cold crystalloid and blood cardioplegia was used. The lowest nasopharyngeal temperature was 33 degrees C There were no episodes of significant hypoxemia, hypercarbia, or acidosis. None of the patients had sickling crisis during the perioperative period. The postoperative blood loss was 687 +/- 135 vs 585 +/- 220 mL in the SCT and control groups, respectively. The trigger for blood transfusion during cardiopulmonary bypass was hematocrit <20% and Hb <75 g/L postopera tively. Three SCT patients (30%) and 10 control patients (33%) received a b lood transfusion. Median extubation time was 4.0 vs 3.9 h; intensive care u nit LOS was 27 vs 28 h; and hospital LOS was 6.0 vs 5.5 days in the SCT and control groups, respectively. There were no intraoperative deaths. One pat ient in the SCT group died from multiorgan failure 2 mo after surgery. Impl ications: Fast-track cardiac anesthesia can be used safely in patients with sickle cell trait undergoing first-time coronary artery bypass graft surge ry. Extubation time and intensive care unit and hospital length of stay are comparable to those of matched controls, and blood loss and transfusion re quirements are not increased. A hematocrit of 20% seems to be a safe transf usion trigger during cardiopulmonary bypass in these patients.