Perioperative management of a rare case of severe polycythemia vera with gout coming for an emergency minor surgery – A concern for the anesthesiologists

Ganapathysubramanian Manujkumar, Amoolya Kamalnath, Ethirajulu Ruthrendra, Venkatesh Ranjan
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引用次数: 0

Abstract

Polycythaemia Vera is a chronic myeloproliferative neoplasm with an unknown etiology and is a rare occurrence. The erythrocytosis and thrombocytosis along with the hypercoagulable state as a direct result of surgery predispose these patients to thrombosis and hence haemorrhage. Here, we report the anaesthetic issues concerning an elderly male patient presenting with complaints of difficulty in passing stools, fever, and cough with mucoid sputum and diagnosed to be having low anal fistula and perianal abscess with presence of haemorrhoids along with polycythaemia and gout, who was not on any treatment, and posted for an emergency perianal abscess drainage and fistulectomy. With a hematocrit of 63.3% and normal arterial oxygen saturation, the anesthetic management included a thorough preoperative evaluation of associated comorbidities, proper positioning, conducting regional anesthesia meticulously and prevention of acute thrombotic or hemorrhagic episodes. The uneventful perioperative period resulted in the smooth recovery of the patient.
一例罕见的严重真性红细胞增多症伴痛风的急诊小手术围手术期处理——麻醉师关注的问题
真性红细胞增多症是一种病因不明的慢性骨髓增生性肿瘤,是一种罕见的疾病。手术直接导致的红细胞增多和血小板增多以及高凝状态使这些患者易形成血栓,从而导致出血。在此,我们报告一位老年男性患者的麻醉问题,其主诉为排便困难、发热、咳嗽和粘液样痰,诊断为低位肛瘘和肛周脓肿伴痔疮、红细胞增多症和痛风,未接受任何治疗,并要求紧急肛周脓肿引流和瘘管切除术。患者的红细胞比容为63.3%,动脉氧饱和度正常,麻醉管理包括术前对相关合并症的全面评估,正确的体位,细致的区域麻醉和预防急性血栓或出血发作。平稳的围手术期使病人顺利康复。
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