Question

Which anaesthetic modality is to be avoided in a patient with sickle cell disease?

• A. General anaesthesia
• B. Brachial plexus block
• C. Intravenous regional anaesthesia
• D. Spinal anaesthesia

Hint:

Which technique deliberately exsanguinates the limb and causes stasis and hypoxia?

Answer 1

The Correct Option is C

Step 1: Understand the pathophysiology: in sickle cell disease, sickling is precipitated by hypoxia, acidosis, venous stasis, dehydration, and hypothermia. The goal is to avoid any technique that promotes these.
Step 2: Intravenous regional anaesthesia (Bier block) requires exsanguination of the limb followed by application of a tourniquet to occlude blood flow. This produces deliberate venous stasis, ischaemia, hypoxia, and acidosis in the isolated limb.
Step 3: These very conditions strongly trigger sickling of red cells, risking a local vaso-occlusive crisis. Therefore IV regional anaesthesia is the modality to be avoided in sickle cell disease.
Step 4: The other options are acceptable when normoxia, normal perfusion, warmth, and hydration are maintained: general anaesthesia, brachial plexus block, and spinal anaesthesia do not mandate prolonged limb exsanguination with a tourniquet.
Conclusion: The modality to avoid is intravenous regional anaesthesia (option 3), matching the printed key.