Bilirubin is a normal by-product that is formed after the breakdown of old red blood cells. It contains haemoglobin – an oxygen carrying protein in blood. Normally. Gilbert’s syndrome, caused by relative deficiency of glucuronyl transferase is the commonest cause of congenital hyperbilirubinemia. We report anesthetic. Gilbert sendromlu hastalarda aort sertliğinin değerlendirilmesi: Amaç: Gilbert sendromu (GS) indirekt bilirubin artışıyla ka- rakterize otozomal.
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Gilbert’s syndrome, caused by relative deficiency of glucuronyl transferase is the commonest cause of congenital hyperbilirubinemia. We report anesthetic management gilbeert a case of Gilbert’s syndrome for laparoscopic cholecystectomy under general anesthesia. Avoiding drugs which use this enzyme for its metabolisim or excretion, and minimizing the stress during the perioperative period allows safe conduct of anesthesia for these patients.
Despite the significant incidence, reports on anesthetic management of patients with Gilbert’s syndrome are few. sendroku
General anesthesia in a patient with Gilbert’s syndrome
A year-old male weighing 65 kg was posted for elective laparoscopic cholecystectomy. He was diagnosed with Gilbert’s syndrome 5 years ago on investigation for persistent yellowish discolouration of sclera which got aggravated during periods of stress and illness and resolved subsequently without any medical intervention. He was quite anxious that his condition would gilbsrt on surgery. Although a familial increase of alkaline phosphatase has been described in Gilbert’s syndrome, being a diagnosed case, it was not repeated preoperatively.
He was premedicated with alprazolam 0. He was scheduled first on the list at 7: Trachea was intubated with cuffed endotracheal tube of 8. Anesthesia was maintained with isoflurane, nitrous oxide and oxygen by the circle system. The intraoperative period was uneventful with stable hemodynamics. Intra-abdominal pressure was kept below 13 mmHg during operation. Neuromuscular blockade was reversed with 0.
Patient was extubated after he was fully awake and responding well to verbal commands. He was subsequently allowed oral fluids 4 hours after the end of surgery. Serum bilirubin and liver function tests were followed up daily for the next 2 days.
Bilirubin settled down to 3. He was discharged on day 3 with standing instructions of reporting immediately if jaundice returned or there sendrpmu symptoms like pain in the abdomen with malaise. His follow-up at 1 week, and subsequently at 1 month, was uneventful. Gilbert’s syndrome is a form of hereditary non-hemolytic jaundice; it is transmitted by autosomal dominant pattern.
Surgery and anesthesia are stressful events, thus there is a possibility that bilirubin may increase postoperatively. Sensromu drugs are metabolized or biotransformed by various enzymes, including glucuronyl transferase, in the liver.
Gilbert’s syndrome can potentially cause such drugs, which utilize these enzymes for its metabolism and ultimate excretion, to accumulate and lead to adverse outcome.
Gilbert’s syndrome is diagnosed clinically by its features, precipitating factors, duration of disease. Diagnosis is confirmed by giving phenobarbital which relieves the jaundice sendomu IV nicotinic acid which aggravates it. It has been found that women taking oral contraceptive pills do not have symptoms as sex hormones induce this enzyme. This might explain the male preponderance. Any stress sendromy aggravate the symptoms of Gilbert’s syndrome e. Since fatty acids compete with unconjugated bilirubin in the liver, any period of prolonged fasting can induce symptoms.
Postoperative jaundice in patients undergoing oral surgery due to the stress of reduced caloric intake has also been reported. To avoid prolonged fasting, we kept this patient first on the list. To overcome stress on the night before surgery alprazolam was prescribed. Five percent dextrose was started early on the morning of surgery to avoid dehydration and gilvert induced stress.
It was converted to a normal saline drip intra-operatively as literature has already established that the stress of surgery and anesthesia results in hyperglycemia due to increased secretion of counter-regulatory hormones like catecholamines, cortisol, glucagon and senddromu hormone. Propofol was chosen over thiopentone or ketamine as it is metabolized by both liver and kidney providing a safety margin. Besides, thiopentone and ketamine alter liver functions in a dose-dependent fashion.
Fentanyl was considered safe as its effect, after sendormu single bolus dose, is terminated by redistribution to muscle and fat. Subsequent metabolism is primarily by N-dealkylation to norfentanyl and its hydroxylation along with norfentanyl. Although there is no evidence in reported literature about prolongation of other muscle relaxants despite the widespread prevalence of Gilbert’s syndrome,[ 2 ] atracurium was preferred due to its Hofmann degradation and glibert hydrolysis.
Mivacurium and Cisatracurium could have been the other safer alternatives due to its similar metabolic pathway. Diclofenac sodium and pentazocine were used for postoperative analgesia. Paracetamol and morphine were specifically avoided.
Although paracatamol is not metabolized by glucuronyl transferase,[ 12 ] it is metabolized by another enzyme, also deficient in some cases of Gilbert’s syndrome[ 1718 ] making these patients susceptible to the potential risk of paracetamol toxicity.
Being the commonest hereditary cause of increased bilirubin and its widespread prevalence, anesthesia can be safely administered in Gilbert’s syndrome provided implications of relative deficiency of glucuronyl transferase on metabolism and excretion of drugs are well understood. To prevent adverse outcome, we should aim should to specifically avoid perioperative stress and ensure adequate hydration. National Center for Biotechnology InformationU.
J Anaesthesiol Clin Pharmacol. Author information Copyright and License information Disclaimer. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC. Abstract Gilbert’s syndrome, caused by relative deficiency of glucuronyl transferase is the commonest cause of congenital hyperbilirubinemia.
Anesthesia, bilirubin, Gilbert’s syndrome, jaundice. Case Report A year-old male weighing 65 kg was posted for elective laparoscopic cholecystectomy. Sendrkmu Gilbert’s syndrome is a form of hereditary non-hemolytic jaundice; it is transmitted by autosomal dominant pattern. Footnotes Source of Support: Nil Conflict of Interest: Liver and biliary tract disease.
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Gilbert’s syndrome – Wikipedia
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