Title : Anaesthetic management of splenectomy across diverse clinical scenarios: A case series of four patients
Abstract:
Background: Splenectomy is performed for a broad range of emergency and elective conditions, each presenting distinct perioperative challenges. Anaesthetic management must be individualized according to the underlying pathology, physiological derangements, and associated comorbidities. This case series highlights tailored anaesthetic strategies employed in four diverse clinical scenarios.
Methods: Four patients undergoing splenectomy were managed using individualized perioperative anaesthetic protocols. The indications included splenic abscess with sepsis and active pulmonary tuberculosis, hereditary spherocytosis with severe haemolytic anaemia, traumatic splenic rupture with haemorrhagic shock, and immune thrombocytopenia refractory to medical therapy. Preoperative optimization, intraoperative monitoring, anaesthetic techniques, transfusion strategies, and postoperative care were adapted to each patient's clinical condition.
Results: All patients underwent successful splenectomy under general anaesthesia with disease-specific perioperative management. Invasive haemodynamic monitoring and blood component therapy were instituted when indicated. Careful optimization, vigilant monitoring, and multidisciplinary collaboration contributed to favourable intraoperative and postoperative outcomes. No major anaesthetic complications occurred. All patients demonstrated satisfactory recovery with favourable clinical and haematological outcomes during follow-up.
Conclusion: Successful anaesthetic management of splenectomy depends on understanding the underlying disease rather than the surgical procedure alone. Individualized perioperative planning, meticulous physiological optimization, appropriate monitoring, targeted transfusion strategies, and multidisciplinary coordination are essential for ensuring safe outcomes across diverse clinical scenarios. This case series emphasizes the importance of a pathology-based anaesthetic approach in both elective and emergency splenectomy.
Keywords: Splenectomy; anaesthesia; case series; hemorrhagic shock; thrombocytopenia; perioperative management
