ANESTHETIC MANAGEMENT FOR A 12 YEAR OLD SICKLE CELL PATIENT WITH INTESTINAL OBSTRUCTION SCHEDULE FOR EMERGENCY EXPLORATORY LAPAROTOMY AT NAKURU COUNTY REFERRAL HOSPITAL (Research Paper Sample)

ANESTHETIC MANAGEMENT FOR A 12 YEAR OLD SICKLE CELL PATIENT WITH INTESTINAL OBSTRUCTION SCHEDULE FOR EMERGENCY EXPLORATORY LAPAROTOMY AT NAKURU COUNTY REFERRAL HOSPITAL
BY
ABDIJABAR MOHAMEDYUSSUF
A Research Paper Submitted to Kenya Medical Training College in Partial Fulfillment of the Requirements for the Award of higher Diploma In Clinical Medicine and Surgery - Anaesthesia
January, 2019
DECLARATION
This research project is my original work, and I confirm that no research has been done, presented or published for award of certificate, higher diploma or degree about the same in the institution.
Student:ABDIJABAR MOHAMED YUSSUF
College number: HND/ANE/1822/055
Signature:...........................
Date:...........................
DEDICATION
This research project is dedicated to my beloved children, and my lovely wife.
ACKNOWLEDGEMENT
My acknowledgement goes to my supervisor, Mr. Ng’ang’a for his efforts contributed immensely to the completion of this project not forgetting Kenya Medical training College and Nakuru Level 5 Hospital as a whole for provision of anaesthesia services. I would also wish to acknowledge my classmates and colleagues for the support they accorded me during the study may God bless you all
ABSTRACT
Sickle cell anemia (SCA), which is due to homozygous inheritance of the HbS variant, is one of the commonly inherited hemoglobinopathies worldwide.Sickle cell disease (SCD) is a complex clinical entity characterized by an inherited chronic hemolytic anemia associated with variable number of acute painful vaso-occlusive episodes. The main aim of the study was to determine the Anesthetic management for a 12 year old sickle cell patient with intestinal obstruction schedule for emergency exploratory laparotomy at Nakuru County referral hospital. The study was guided by the following specific objectives; to determine the Peri-operative management of patients with sickle cell disease and to identify the anesthetic challenges posed by patients with sickle cell disease undergoing emergency exploratory laparotomy at Nakuru county referral hospital. This study was conducted in Nakuru Level five hospital located in Nakuru County. The study population was a total group of people or things meeting the designated interest to the researcher. The study population includes the target population and the accessible population. In this study, the target population consists of sickle cell patient with intestinal obstruction schedule for emergency exploratory laparotomy at Nakuru County referral hospital. Sample selection is the process of selecting a portion of the designated population to represent the entire population. In this study the participant was selected using simple random sampling among patients admitted with intestinal obstruction in sickle cell patient. This study was conducted in Nakuru Level five hospital located in Nakuru County. The study population is the total group of people or things meeting the designated interest to the researcher. The study population includes the target population and the accessible population. In this study, the target population consists of sickle cell patient with intestinal obstruction schedule for emergency exploratory laparotomy at Nakuru County referral hospital. Sample selection is the process of selecting a portion of the designated population to represent the entire population. In this study the participant was selected using simple random sampling among patients admitted with intestinal obstruction in sickle cell patient. Vaso-occlusive phenomena and hemolysis are the clinical hallmarks of SCD, an inherited disorder due to homozygosity for the abnormal hemoglobin, that is, HbS. Vaso-occlusion results in recurrent painful episodes and a variety of serious organ system complications that can lead to disabilities and early death. Acute chest syndrome is one of the most serious complications of SCD, with a mortality rate of 10%, but its pathogenesis is not clearly understood. Progressive fibrosis has been detected in younger patients with multiple episodes of acute chest crisis. Proper planning and optimal perioperative preparation is a key to successful management of SCD patients. Adequate hydration to decrease the viscosity of blood, control of infections and getting the hemoglobin levels normal and PCV between 30% and 35% is essential. Exchange transfusion is generally recommended before major surgical interventions in order to minimize sickling and reduce the circulating HbS concentration below 30%. In conclusion, meticulous anesthetic management in the form of avoiding acidosis, hypoxia, hypothermia, hypovolemia, maintaining normocarbia, good intraoperative and postoperative pain relief with epidural infusion, postoperative thromboprophylaxis, postoperative oxygen therapy with inspired concentration up to 40%, chest physiotherapy, nebulization, incentive spirometry with early mobilization and regular ABG monitoring played an important role in improving the patient outcome. Postoperative monitoring and pain relief play a vital role in avoiding pulmonary complications.