{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T01:45:27Z","timestamp":1793324727106,"version":"4.5.0"},"reference-count":25,"publisher":"American Dental Society of Anesthesiology (ADSA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009]]},"abstract":"<jats:title>Abstract<\/jats:title>\n        <jats:p>Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic disorder of red blood cells in humans. It is estimated that about 400 million people are affected by this deficiency.1 The G6PD enzyme catalyzes the first step in the pentose phosphate pathway, leading to antioxidants that protect cells against oxidative damage.2 A G6PD-deficient patient, therefore, lacks the ability to protect red blood cells against oxidative stresses from certain drugs, metabolic conditions, infections, and ingestion of fava beans.3 The following is a literature review, including disease background, pathophysiology, and clinical implications, to help guide the clinician in management of the G6PD-deficient patient. A literature search was conducted in the following databases: PubMed, The Cochrane Library, Web of Science, OMIM, and Google; this was supplemented by a search for selected authors. Keywords used were glucose-6-phosphate dehydrogenase (G6PD) deficiency, anesthesia, analgesia, anxiolysis, management, favism, hemolytic anemia, benzodiazepines, codeine, codeine derivatives, ketamine, barbiturates, propofol, opioids, fentanyl, and inhalation anesthetics. Based on titles and abstracts, 23 papers and 1 website were identified. The highest prevalence of G6PD is reported in Africa, southern Europe, the Middle East, Southeast Asia, and the central and southern Pacific islands; however, G6PD deficiency has now migrated to become a worldwide disease. Numerous drugs, infections, and metabolic conditions have been shown to cause acute hemolysis of red blood cells in the G6PD-deficient patient, with the rare need for blood transfusion. Benzodiazepines, codeine\/codeine derivatives, propofol, fentanyl, and ketamine were not found to cause hemolytic crises in the G6PD-deficient patient. The most effective management strategy is to prevent hemolysis by avoiding oxidative stressors. Thus, management for pain and anxiety should include medications that are safe and have not been shown to cause hemolytic crises, such as benzodiazepines, codeine\/codeine derviatives, propofol, fentanyl, and ketamine. The authors of this article make 5 particular recommendations: (1) Anyone suspected of G6PD deficiency should be screened; (2) exposure to oxidative stressors in these individuals should be avoided; (3) these patients should be informed of risks along with signs and symptoms of an acute hemolytic crisis; (4) the clinician should be able to identify both laboratory and clinical signs of hemolysis; and finally, (5) if an acute hemolytic crisis is identified, the patient should be admitted for close observation and care.<\/jats:p>","DOI":"10.2344\/0003-3006-56.3.86","type":"journal-article","created":{"date-parts":[[2010,3,1]],"date-time":"2010-03-01T08:00:24Z","timestamp":1267430424000},"page":"86-91","source":"Crossref","is-referenced-by-count":67,"title":["Perioperative Management of the Glucose-6-Phosphate Dehydrogenase Deficient Patient: A Review of Literature"],"prefix":"10.2344","volume":"56","author":[{"given":"Cpt Ali R.","family":"Elyassi","sequence":"first","affiliation":[{"name":"OMFS PGY2 Resident, Tripler Army Medical Center, Honolulu, Hawaii"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maj Henry H.","family":"Rowshan","sequence":"additional","affiliation":[{"name":"OMFS Residency Associate Professor, Tripler Army Medical Center, Honolulu, Hawaii"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1191","reference":[{"key":"i0003-3006-56-3-86-Glader1","series-title":"Wintrobe's Clinical Hematology. 10th ed","first-page":"1176","article-title":"Glucose-6-phosphate dehydrogenase deficiency and related disorders of hexose monophosphate shunt and glutathione metabolism.","author":"Glader, B. E.","year":"2008","unstructured":"Glader, B. E.\n          \n          Glucose-6-phosphate dehydrogenase deficiency and related disorders of hexose monophosphate shunt and glutathione metabolism.\n          In:. Wintrobe's Clinical Hematology. 10th ed. BaltimoreWilliams & Wilkins. 2008. 1176\u20131190."},{"key":"i0003-3006-56-3-86-Luzzatto1","series-title":"The Metabolic and Molecular Basis of Inherited Disease. 8th ed","first-page":"4517","article-title":"Glucose-6-phosphate dehydrogenase deficiency.","author":"Luzzatto, L.","year":"2001","unstructured":"Luzzatto, L., A.Metha, and T.Vulliany. Glucose-6-phosphate dehydrogenase deficiency.In:Scriver, C. R., A. L.Beaudet, W. S.Sly, et al. The Metabolic and Molecular Basis of Inherited Disease. 8th ed. ColumbusMcGraw-Hill. 2001. 4517\u20134553."},{"key":"i0003-3006-56-3-86-Cappellini1","series-title":"Lancet","first-page":"64","article-title":"Glucose-6-phosphate dehydrogenase deficiency.","volume":"371","author":"Cappellini, M. 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E.Buyukokuroglu. In vitro effects of some anesthetic drugs on enzymatic activity of human red blood cell glucose-6-phosphate dehydrogenase.Polish J Pharmacol2002. 54:67\u201371."},{"key":"i0003-3006-56-3-86-Basora1","series-title":"Rev Esp Anesthesiol Reanim","first-page":"380","article-title":"Glucose-6-phosphate dehydrogenase deficiency: anesthetic implications.","volume":"37","author":"Basora, M.","year":"1990","unstructured":"Basora, M., A.Villaonga, and M. A.Ayuso. Glucose-6-phosphate dehydrogenase deficiency: anesthetic implications.Rev Esp Anesthesiol Reanim1990. 37:380."},{"key":"i0003-3006-56-3-86-Srikanth1","series-title":"Obes Surg","first-page":"584","article-title":"Topical benzocaine (hurricaine) induced methemoglobinemia during endoscopic procedures in gastric bypass patients.","volume":"15","author":"Srikanth, M. S.","year":"2005","unstructured":"Srikanth, M. S., R.Kahlstrom, K. H.Oh, et al. Topical benzocaine (hurricaine) induced methemoglobinemia during endoscopic procedures in gastric bypass patients.Obes Surg2005. 15:584\u2013590."},{"key":"i0003-3006-56-3-86-Hegedus1","series-title":"Anesth Prog","first-page":"136","article-title":"Benzocaine-induced methemoglobinemia.","volume":"52","author":"Hegedus, F.","year":"2005","unstructured":"Hegedus, F. and K.Herb. Benzocaine-induced methemoglobinemia.Anesth Prog2005. 52:136\u2013139."},{"key":"i0003-3006-56-3-86-Burka1","series-title":"Ann Intern Med","first-page":"817","article-title":"Clinical spectrum of hemolytic anemia associated with glucose-6-phosphate dehydrogenase deficiency.","volume":"64","author":"Burka, E. R.","year":"1966","unstructured":"Burka, E. R., Z.WeaverIII, and P. A.Marks. 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Q.\n          \n          Anemia and the liver: hepatobiliary manifestations of anemia.\n          Clin Liver Dis\n          2002. 6:891\u2013907."},{"key":"i0003-3006-56-3-86-Sklar1","series-title":"Pharmacotherapy","first-page":"656","article-title":"Hemolysis as a potential complication of acetaminophen overdose in a patient with glucose-6-phosphate dehydrogenase deficiency.","volume":"22","author":"Sklar, G. E.","year":"2002","unstructured":"Sklar, G. E.\n          \n          Hemolysis as a potential complication of acetaminophen overdose in a patient with glucose-6-phosphate dehydrogenase deficiency.\n          Pharmacotherapy\n          2002. 22:656\u2013658."},{"key":"i0003-3006-56-3-86-Stoelting1","series-title":"Basics of Anesthesia. 5th ed","first-page":"361","author":"Stoelting, R. K.","year":"2007","unstructured":"Stoelting, R. K. and R. D.Miller. Basics of Anesthesia. 5th ed. PhiladelphiaChurchill Livingstone. 2007. 361."}],"container-title":["Anesthesia Progress"],"original-title":[],"link":[{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/view\/journals\/anpr\/56\/3\/article-p86.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/anesthesia-progress\/article-pdf\/56\/3\/86\/2100708\/0003-3006-56_3_86.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/downloadpdf\/journals\/anpr\/56\/3\/article-p86.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/downloadpdf\/journals\/anpr\/56\/3\/article-p86.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T12:19:54Z","timestamp":1728303594000},"score":1,"resource":{"primary":{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/view\/journals\/anpr\/56\/3\/article-p86.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009]]},"references-count":25,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.2344\/0003-3006-56.3.86","relation":{},"ISSN":["0003-3006","1878-7177"],"issn-type":[{"value":"0003-3006","type":"print"},{"value":"1878-7177","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009]]}}}