Background: Sickle cell disease (SCD) and electrical burn injuries are unique entities. SCD is an inherited condition due to a mutation in the β-globin gene, which encodes a variant of haemoglobin A and the prevalence in Sub-Saharan Africa is approximately 30%. Electrical burns result in morbidity higher than expected based on burned area.
There are no reports in the literature about the anaesthetic management of these conditions happening at the same time.
Case report: We present the case of a 19 years old man, native of Equatorial Guinea, with a history splenectomy, admitted due to high-voltage electric burns. 
On arrival at the hospital he was haemodynamically stable (BP 119/85, HR 85 bpm, RR 22 bpm), no dyspnoea or airway compromise, SpO2 100%. No inhalation syndrome and a glasgow coma scale of 15. He had 2% burned body surface to deep dermis. No compartmental syndrome. Laboratory analysis showed normocitic anaemia (Hb 8,4 g/dL; MCV 91.3fL). The haematology consultant observed poikilo-drepanocytosis, target cells and schistocytes on blood smear, being diagnosed with SCD, which was unknown up to this moment. He remained in the ICU, required several transfusions to maintain a Hb up to 7.5g/dl and had an acute sickle cell exacerbation with abdominal pain that was controlled with adequate hydration and correction of anaemia. Burns debridement was scheduled in the fourth day of admission. General anaesthesia, with a laryngeal mask and ASA standard monitoring, was induced using midazolam, fentanyl and propofol. Maintenance was performed with sevoflurane and remifentanyl. Inspired oxygen fraction was set to SatO2 >95%, and adequate hydration, fluid heater, and thermal blanket were used in order to avoid triggers of vaso-occlusive crises. We gave morphine chloride and paracetamol for postoperative analgesia. Total bleeding was 300 ml. We awaken the patient in the operating room and transferred him to the ICU uneventfully. 
Discussion: During surgeries in patients with SCD special care must be taken to avoid triggers of acute attacks, specially: hypoxia, dehydration, pain, and cold. 
In this case we emphasise: good hydration to the patient, taking into account the losses before and during surgery; adequate oxygenation; proper management of the airway, preventing discomfort during handling and adequate analgesia during and after surgery.

Anaesthetic management of electrical burn in a patient with sickle cell disease