P060: A PATIENT SAFETY QUALITY INITIATIVE TO DECREASE RISK OF ACUTE CHEST SYNDROME POST ANESTHESIA IN PATIENT WITH DIAGNOSED SICKLE CELL DISEASE
Hope Sprunger, MD; Sonia Mehta, MD; University of Florida
Introduction: Sickle cell disease due to its challenges to blood circulation presents specific considerations for the anesthesiologist, including pain control, infection control, hydration, hemoglobin concentration, and temperature. For one pediatric case, an 8 year-old boy with PMH of sickle cell anemia with recurrent pain crises was scheduled for a MRI of 30 minute duration. Post procedure, the patient was diagnosed with acute chest syndrome. We will discuss the management of patient care and the outcome of this case which ultimately led to the birth of a multidisciplinary patient safety quality initiative.
Management: Patient was instructed to follow NPO guidelines that would require him to be NPO at midnight the night before the MRI.The patient arrived to MRI and had eaten a full breakfast. Due to NPO violations and aspiration risks, the patient was delayed until appropriate fasting time ensued for this elective anesthetic. Patient had had recurrent sickling crisises resulting in hospitalization for acute chest syndrome. Therefore, hydration status was a huge concern. Several hours prior to the MRI, an awake PIV was placed and patient was given intravenous fluid. Patient was placed under GA with a propofol infusion and LMA was placed. Patient was maintained warm, was hydrated during the procedure, and woke with no complications on tube removal. During recovery in PACU, the patient began to complain of pain and was admitted for acute pain crisis.
Results: A multidisciplinary team formed based on the event that occurred to this patient. Pediatric hematology/oncology, radiology, MRI technicians, and pediatric anesthesiology met to discuss how to prevent this situation going forward. A protocol was created that ensued patient’s who have a PMH of sickle cell disease will be admitted the night prior to MRI for PIV placement and hydration. Since the creation of this protocol, there have not been any patient’s who have suffered from acute chest syndrome secondary to the stress of anesthesia after their MRI.
Conclusion: Stress from fasting and general anesthesia in the pediatric sickle cell population can result in a pain crisis even with a nonsurgical procedure such as a MRI despite appropriate attempts at care. Education of providers and developing a standardized approach to pre-treatment during the NPO period can help prevent future admissions from pain crises caused by fasting.