La formule CPK-EPI est la meilleure méthode pour estimer le débit de filtration glomérulaire chez les patients drépanocytaires adultes

Pharmacodynamic of rocuronium in sickle cell patients

BACKGROUND

Sickle cell disease is the most widespread genetic disease in the world. The chronic organ damage due to this disease could lead to variability of responses to the anaesthetic drugs. We analysed the pharmacodynamics response of rocuronium to sickle cell patients.

METHODS

We observed and compared the onset time and clinical duration (time to recovery first twitch) of 0.6 mg kg^-1 of rocuronium using a TOFscan® monitor, as well as the time before the first incremental dose (time to recovery second twitch), in a group of 22 homozygous sickle cell patients and a group of 23 controls, all programmed for laparoscopic surgical procedures.

RESULTS

The onset time of rocuronium was longer in sickle cell patients [mean ± SD (extremes)], [6.3 ± 2.1 (1.8-10) min] than in the control group [2.5 ± 0.6 (1.4-3.5) min] (P < 0.01). The clinical duration was shorter in sickle cell patients [19.2 ± 7.1 (13-41) min] when compared to the control group [28.9 ± 6.9 (21-48) min] (P < 0.01). The time before the first incremental dose was shorter in the sickle cell patients group [27.7 ± 7.9 (19-49) min] compared to the control group [39.9 ± 8.7 (30-56) min] (P < 0.01).

CONCLUSION

The onset time and duration of action of rocuronium was significantly shorter in patients with sickle cell disease versus the general population.

[Hyperuricemia in sickle cell disease in France]

PURPOSE

Hyperuricemia has been reported to be a common feature of sickle cell disease occurring between 32 to 41% of the patients, in studies conducted during the 1970's. Since then, this notion has been rarely challenged. The objective of this study was to assess the prevalence of hyperuricemia and gout in adult patients with sickle cell disease in France.

METHODS

Between May 2007 and March 2009, serum and urinary urate concentration, creatininemia and hemogram were prospectively assessed in all consecutive sickle cell patients, followed in our sickle cell disease centre. All subjects were in a clinically steady state. Clinical acute gout history was also recorded.

RESULTS

Sixty-five patients (mean age 31±10.3 years) were investigated. Mean uric acid serum level was 281.6±74μmol/L. Hyperuricemia was evidenced in six patients only (9.2%) (95% IC: 3.5-19.0). None of the patient had a medical history of acute gout. Patients in the higher serum uric acid tertile concentration had higher serum creatinine level (62.3±17.1μmol/L vs 51.5±12.6μmol/L, P<0.01), lower fractional excretion of urate (4.5% vs 6.8%, P<0.03) and higher reticulocyte count (median 219500/mm(3) vs 144000/mm(3), P=0.08) compared to the other patients.

CONCLUSION

Hyperuricemia and gout are not a clinical problem in sickle cell disease in our country. Nevertheless, our findings indicate that kidney function has to be fully explored if serum uric acid level is elevated or significantly deteriorates during follow-up. Serum uric acid level could be an early marker of renal dysfunction in sickle cell disease patients.