Anesthetic considerations in a patient with visceral leishmaniasis

Purpose: To describe the anesthetic problems in a patient with visceral lei shmaniasis undergoing general anesthesia. Clinical features: A 17-yr-old man with visceral leishmaniasis was booked f or emergency appendectomy. He received parentral sodium stibogluconate 600 mg per day. The patient was pale, afebrile and had hepatosplenomegaly. Preo perative investigations showed a hemoglobin of 6.2 g(.)dL (1), platelet cou nt of 80 x 10(9.)L(-1) and serum albumin of 2.1 g(.)dL(-1). The electrocard iogram and chest x-ray were normal. Anesthesia was induced with 100 mug fen tanyl and 50 mg propofol iv and tracheal intubation was facilitated with 3 mg vecuronium iv. Maintenance of anesthesia was done with intermittent posi tive pressure ventilation using 50% nitrous oxide and 0.4% isoflurane in ox ygen. Reversal of neuromuscular blockade was achieved with 1.0 mg neostigmi ne and 0.2 mg atropine iv. 50 mg tramadol iv every six hours was used for p ostoperative analgesia. The perioperative course was uneventful. Conclusion: Patients with visceral leishmaniasis have problems unique to th em that may influence the anesthetic management. Of particular concern to a n anesthesiologist are the presence of hematological abnormalities (anemia, leukopenia, thrombocytopenia), and hypoalbuminic malnutrition. The combina tion of low hemoglobin and thrombocytopenia may necessitate blood component therapy perioperatively. Drugs affecting coagulation should be used judici ously. Hypoalbuminemia may adversely affect the pharmacokinetics of agents that are highly protein bound. The anesthetic management in a patient with visceral leishmaniasis may be further complicated by the presence of coexis ting infections like pneumonia and tuberculosis. Leishmaniasis is a recogni zed complication of infection with human immunodeficiency virus.