Comparison of the effects of spinal epidural and general anesthesia on coagulation and fibrinolysis in laparoscopic cholecystectomy: a randomized controlled trial: VSJ Competition, 2 place.

Abstract

IntroductionLaparoscopic cholecystectomy (LC) is usually performed under general anesthesia. Recently, laparoscopic cholecystectomy under regional anesthesia has become popular, but this creates a serious risk of thromboembolism because of pneumoperitoneum, anesthesia technique, operative positioning, and patient-specific risk factors.AimThis randomized controlled trial compares the effects of two different anesthesia techniques in laparoscopic cholecystectomy on coagulation and fibrinolysis.Material and methodsThis randomized prospective study included 60 low-risk patients with deep vein thrombosis (DVT) who underwent elective LC without thrombo-emboli prophylaxis. The patients were randomly divided into two groups according to the anesthesia technique: the general anesthesia (group 1, n = 30) and spinal epidural anesthesia (group 2, n = 30) groups. Measurement of the prothrombin time (PT), thrombin time (TT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), and blood levels of D-dimer (DD) and fibrinogen (F) were recorded preoperatively (pre), at the first hour (post 1) and 24 h (post 24) after the surgery. These results were compared both between and within the groups.ResultsThe mean age was 51.5 ±16.7 years (range: 19–79 years). Pneumoperitoneum time was similar between group 1 (33.8 ±7.8) and group 2 (34.8 ±10.4). The TT levels significantly declined postoperatively in both groups. The levels of PT, aPTT, INR, D-dimer and fibrinogen dramatically increased postoperatively in both groups.ConclusionsWhile there was not any DVT, there was a significant decline in TT. There was a dramatic rise in the PT, INR, D-dimer, fibrin degradation products (FDP), and fibrinogen following LC. This may be attributed to the effects of pneumoperitoneum and anesthesia techniques on portal vein flow.

Alterations of coagulation and fibrinolysis in patients with blunt splenic injury after splenic artery embolization

“…Short PT and APTT predict hypercoagulable state. The TT reflects the coagulation and anticoagulation cascade and fibrinolysis 21 . However, our study failed to find a significant difference in AT III, PT, APTT, and TT between pre‐ and post‐embolization in BSI patients.…”

Perioperative effects of desflurane versus propofol on hemostasis guided by thromboelastometry in splenectomy with liver cirrhosis

“…During laparoscopic cholecystectomy and constant pneumoperitoneum, the levels of fibrinogen, DD, PT, APTT, and INR were higher during regional anesthesia receiving combined spinal epidural compared to patients anesthetized by general anesthesia using sevoflurane and compared to preoperative values. This may be attributed to the effects of pneumoperitoneum and anesthesia techniques on portal vein flow [29].…”

Effect of obesity on venous hemodynamics of the lower limbs during laparoscopic cholecystectomy

“…Besides, general anesthesia affects the hemostatic state by affecting platelet function and bleeding time during LC. 16,17 Moreover, carbon dioxide pneumoperitoneum may cause an increase in the blood viscosity, red cell aggregation, and decrease in red cell deformability, thereby increasing the possibility of thrombosis. Numerous methods (e.g., color Doppler ultrasound, venography, photoplethysmography, or spiral computed tomographic angiography) are adopted to study the hemodynamics of veins of lower limbs.…”

“…Besides, general anesthesia affects the hemostatic state by affecting platelet function and bleeding time during LC. 16,17 Moreover, carbon dioxide pneumoperitoneum may cause an increase in the blood viscosity, red cell aggregation, and decrease in red cell deformability, thereby increasing the possibility of thrombosis.…”