Anesth Pain Med.  2017 Jul;12(3):243-246. 10.17085/apm.2017.12.3.243.

Anesthetic management of a patient with glucose-6-phosphate dehydrogenase deficiency undergoing robot-assisted laparoscopic surgery: A case report

• Cho H
• Lee SY
• Kim GH
• Kim J
• Koo MS
• Yun M
• Kwon MY

• KMID: 2388840
• DOI: http://doi.org/10.17085/apm.2017.12.3.243

Abstract

The authors describe the successful perioperative management of a 3-year-old boy from Dubai with glucose-6-phosphate dehydrogenase (G6PD) deficiency, who underwent robot-assisted laparoscopic pyeloplasty for complete right ureteropelvic junction obstruction. G6PD deficiency is a genetic disorder predisposing patients to hemolytic anemia from oxidative stress. Important considerations in anesthetic management include avoiding oxidative stress, which can be caused by various conditions, and monitoring for hypercapnia, which can cause acidosis and hemolysis. Laparoscopic surgery is usually associated with hypercapnia and therefore an increased risk for respiratory acidosis. During surgery in this particular case, efforts were made to avoid carbon dioxide retention and to keep the patient warm. General anesthesia was induced with thiopental sodium, rocuronium, and fentanyl, and maintained with sevoflurane. There were no signs of hemolysis in the perioperative period and he was discharged owing to his improved condition.

Keyword

Glucose-6-phosphate dehydrogenase deficiency; Respiratory acidosis

MeSH Terms

Acidosis
Acidosis, Respiratory
Anemia, Hemolytic
Anesthesia, General
Carbon Dioxide
Child, Preschool
Fentanyl
Glucose-6-Phosphate*
Glucosephosphate Dehydrogenase Deficiency*
Glucosephosphate Dehydrogenase*
Hemolysis
Humans
Hypercapnia
Laparoscopy*
Male
Oxidative Stress
Perioperative Period
Thiopental
Carbon Dioxide
Fentanyl
Glucose-6-Phosphate
Glucosephosphate Dehydrogenase
Thiopental

Figure

• 

  Fig. 1 Pentose phosphate pathway. G6PD: glucose-6-phosphate dehydrogenase, NADP＋: nicotinamide adenine dinucleotide phosphate, NADPH: reduced NADP, GSSG: oxidized glutathione, GSH: reduced glutathione, H2O2: hydrogen peroxide.

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