rocuronium and Purpura--Thrombocytopenic--Idiopathic

A 44-year-old man diagnosed of common variable immunodeficiency associated with thrombopenia due to autoimmunity required anesthesia for anal fissure repair and hemorrhoidectomy. Hemostatic complications developed after surgery, with extreme thrombopenia (1,000 platelets/pl) and analytical changes that necessitated administration of six units of platelets from apheresis, as well as immunoglobulins, antifibrinolytic agents (e-aminocaproic acid) and granulocytic colony stimulating factors. Anesthesia for such patients is reviewed, with emphasis on careful management of the airways, preparation of sufficient material for surgery (rapid transfusion equipment, large caliber intravenous catheters, sterile material) and orientation of anesthetic technique toward general anesthesia through a laryngeal mask.

Topics: Adjuvants, Anesthesia; Adult; Aminocaproic Acid; Androstanols; Anesthesia, Inhalation; Anesthetics; Atropine; Autoimmune Diseases; Bromazepam; Combined Modality Therapy; Common Variable Immunodeficiency; Fentanyl; Fissure in Ano; Granulocyte Colony-Stimulating Factor; Hemorrhoids; Humans; Hypnotics and Sedatives; Immunoglobulins, Intravenous; Laryngeal Masks; Male; Methyl Ethers; Nitrous Oxide; Platelet Transfusion; Postoperative Complications; Preanesthetic Medication; Pregnenediones; Propofol; Purpura, Thrombocytopenic, Idiopathic; Ranitidine; Rocuronium; Sevoflurane; Thrombocytopenia