Sickle cell disease

Top concerns

1. 1.Prevent the sickling triad-plus: hypoxemia, hypothermia, acidosis, dehydration, and venous stasis — through emergence, not just induction
2. 2.Preoperative transfusion: for moderate-risk surgery, simple transfusion targeting Hb ~10 g/dL reduced complications (TAPS) — coordinate with hematology
3. 3.Acute chest syndrome is the feared postop event — incentive spirometry, oxygenation, early mobilization, adequate analgesia
4. 4.Pain management: many patients are opioid-experienced; multimodal + their baseline requirements, not suspicion
5. 5.Tourniquets: not absolutely contraindicated but use selectively with meticulous exsanguination and oxygenation
6. 6.Keep them warm, wet (euvolemic), and oxygenated — the whole perioperative arc

Drug do's and don'ts

• PREFERRegional techniques— Excellent analgesia reduces splinting/ACS risk; no evidence of harm from neuraxial.
• AVOIDAggressive diuresis / prolonged NPO without IV fluids— Dehydration is a direct sickling trigger.
• PREFERSupplemental O₂ through transport and PACU— Cheap insurance against the primary trigger.

Airway & positioning

• No unique airway anatomy — the airway plan is about maintaining oxygenation margins
• Position to avoid venous stasis; padding + normothermia devices from the start

Pearls

• Your anesthetic record — temp, SpO₂, fluids — is the sickle-crisis prophylaxis.
• Postop day 2–3 chest pain in SCD is acute chest syndrome until proven otherwise; hand that off explicitly.

Suggested reading

• Stoelting's Anesthesia and Co-Existing Disease, 8e
• Howard et al., TAPS trial, Lancet 2013

Educational quick-reference only — defer to clinical judgment, institutional protocols, and the primary texts above.