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May 11, 1957


JAMA. 1957;164(2):137-141. doi:10.1001/jama.1957.02980020017004

• The choice of anesthetics for patients undergoing splenectomy is considered on the basis of experience with 205 patients who had various blood dyscrasias. Congenital spherocytosis was present in 33 patients, and light cyclopropane anesthesia plus administration of tubocurarine, with controlled respiration, was used in 22 of these. It afforded a stable cardiocirculatory state without significant complications either during or after surgery. A second group consisted of 49 patients with acquired hemolytic anemia, a third of 79 with thrombocytopenic purpura, and a fourth of 44 patients with pancytopenia, neutropenia, and aplastic anemia. Complications were most numerous in the purpuric group, in which the splenectomy often failed to have a therapeutic effect, so that there were seven postoperative deaths. It was not found necessary to choose anesthetic agents for the sake of their effects on the contractility of the spleen. The choice was made, rather, on the basis of the patient's liability to hemorrhage and hypotension. Endotracheal and intestinal intubation were avoided whenever the platelet count was low, in order to reduce the danger of bleeding; spinal anesthesia was avoided when the circulating blood volume was low. The policy was to maintain an adequate blood volume with transfusions of fresh, whole blood, but to transfuse cautiously in cases of acquired hemolytic anemia because of the hazard of severe hemolytic reactions.