P036: ANESTHETIC MANAGEMENT FOR A 9 YEAR OLD MALE WITH G6PD DEFICIENCY UNDERGOING GENERAL ANESTHESIA
Harshvardhan Rajen, MD; Juan Ojeda, MD; Eric Amaro; Kendall Regional Medical Center
Introduction: The patient is a 9 year old male with past medical history of glucose-6-phosphate dehydrogenase deficiency who presented after a fall with a fracture of the left elbow. Patient was evaluated by orthopedics and the decision was made for open reduction and internal fixation of the injury in the operating room.
Methods: The patient underwent general anesthesia. However, due to his medical history no local anesthetic medications were given, and only midazolam, fentanyl, propofol, zofran, and sevoflurane were administered to the patient. During the procedure the anesthesiologist discussed with the operating surgeon the need to reduce the time the tourniquet was applied to the upper extremity as well as reducing the maximum pressure of the tourniquet.
Results: The patient tolerated the procedure well and without complications and was discharged the following day.
Discussion: Patients with glucose-6-phosphate dehydrogenase deficiency may develop crises when exposed to oxidative stress, which may be triggered by pharmacologic agents. Local anesthetics have been shown to produce methemoglobinemia as and such should be avoided in these patients as local anesthetics are frequently administered during all types of anesthetic. Reducing tourniquet maximum pressure as well as the time the tourniquet is inflated reduces the risk of causing oxidative stress to the patient and will therefore reduce the risk of developing a crisis.