Caudal analgesia application with bupivacaine in a pediatric patient with glucose-6-phosphate dehydrogenase enzyme deficiency; case report

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Glucose-6-phosphate dehydrogenase enzyme has a cells protecting feature from oxidative damage. Glucose-6-phosphate Dehydrogenase Enzyme Deficiency is a hereditary disease that causes hemolysis in cases of deficiency due to mutation in the X chromosome, due to oxidative stresses such as some drugs, chemicals or infection. The preoperative Hb of a 4-year-old patient who was to undergo circumcision surgery was determined as 8.9 g/dL. Since increased bleeding was not expected during this procedure, no attempt was made to increase the hemoglobin value. After the induction of general anesthesia with sevoflurane 8%, 1 ml/kg of 0.25% bupivacaine was administered caudally to the patient. The hemodynamic findings remained within normal limits during the surgical procedure. In the follow-up, it was determined that the pain score was low and that no additional analgesic drugs were required. Afterwards, no additional hematological abnormalities were detected and the patient was discharged two days later. We believe that during surgery, when routine monitoring measures are taken and conditions that may cause stress to the patient such as hypotension, hypoxemia, and dehydration are avoided, the patient's anesthesia and postoperative pain can be controlled with a general anesthetic gas such as sevoflurane and a local anesthetic such as bupivacaine, with attention to toxic doses.