Pub No: OS-18
Caudal Analgesia in a Pediatric Patient with Glucose-6-Phosphate

Dehydrogenase Deficiency

Mehmet KARA1, Cevdet YARDIMCI1, Yeşim ANDIRAN ŞENAYLI1

1Yozgat Bozok Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon AD

Introduction - Purpose: Many agents used in anesthesia can cause hemolysis in patients with glucose-6-phosphate dehydrogenase enzyme deficiency. In this case, we aimed to present the anesthesia management of a child with G6PDH enzyme deficiency who underwent orchidopexy and circumcision.

Phenomenon: Orchidopexy and circumcision surgery was planned for a 4-year-old male patient by the pediatric surgeon. It was learned that he was diagnosed by the pediatric clinic at the age of 2 and that he didn’t have a hemolytic crisis. After oral midazolam premedication, he was induced with sevoflurane in the operating room. After intravenous propofol, a laryngeal mask was placed. 1 mL/kg 0.25% bupivacaine was applied to the epidural space. Sevoflurane was used to maintain anesthesia. Intraoperative hypotension, hyperthermia, and hematuria were not observed and there was no need for opioids. After 80 minutes of surgery, no problems were observed in the recovery unit. The patient was stable during follow-up and was discharged on the 2nd postoperative day.

Discussion - Conclusion: G6PDH enzyme deficiency is a serious recessive disease caused by mutation on the X chromosome, resulting in acute hemolysis after exposure to oxidative stress(1). In G6PD deficiency, avoiding situations that may cause oxidative stress and controlling pain are important to prevent acute hemolysis(2).Anesthetic agents such as midazolam, diazepam, ketamine, sevoflurane, and prilocaine have been associated with hemolysis in G6PD deficiency(3). Prilocaine and lidocaine should be avoided in individuals with G6PD deficiency due to the risk of methemoglobinemia(4). Bupivacaine is safe in G6PD deficiency(4). We applied the caudal analgesia technique to our patient for intraoperative analgesia and postoperative pain control. Successful postoperative analgesia was achieved in our patient, who didn’t require analgesic for 30 hours postoperatively. We evaluate that caudal analgesia using bupivacaine is a safe and effective method for postoperative analgesia in patients with G6PD enzyme deficiency and who will undergo general anesthesia.

Keywords: Postoperative analgesia, Caudal Analgesia, Pediatric Patient with Glucose-6- Phosphate Dehydrogenase Deficiency