RESUMO
62 patients with homozygous sickle cell (SS) disease who were subjected to cholecystectomy for symptomatic gall stones were analysed to determine the frequency and outcome of postoperative acute chest syndrome (ACS). Patients were selectively transfused preoperatively where haemoglobin levels were found to be >1 g/dl below steady state values. All patients had open cholecystectomy. 11 patients developed postoperative ACS. Age range was 8 to 54 years among cholecystectomy patients and 10 to 38 years among ACS cases. Two of the 11 received preoperative simple transfusion and haemoglobin levels ranged from 5.6 to 8.6 g/dl among the 9 not transfused. ACS precipitated falls in O2 partial pressures below 70 mm Hg on room air in 10 of the 11 cases. All but one of the patients received therapeutic transfusion (3 exchange and 7 simple) during their phase of clinical deterioration culminating in multi-system failure. ACS remains the leading cause of post operative morbidity and mortality in sickle cell disease. Hydration attention to infection, oxygen therapy via mask or positive pressure ventilation, simple or exchange transfusion and chest physiotherapy remain standard treatment. The potential for multi-system failure makes patient outcome unpredictable.(AU)
