The influence of different procedures of general anaesthesia on platelet function, coagulation and the fibrinolytic system

Abstract

We investigated whether different procedures during general anaesthesia alter platelet activation in vivo and/or activate coagulation and fibrinolysis. Forty-one healthy adult patients, scheduled for elective ophthalmic surgery under general anaesthesia, were studied with regard to changes of plasma beta-thromboglobulin (beta TG, index of platelet activation), thrombin-antithrombin III-complex (TAT, index of activation of coagulation) and d-dimer (index of fibrinolysis) during anaesthesia. The patients underwent either inhalation anaesthesia with enflurane and nitrous oxide or balanced anaesthesia with enflurane (0.5% end-tidal concentration) and alfentanil. Ten minutes after intubation the beta TG level was significantly reduced compared to the preoperative value in both general anaesthesia groups. Balanced anaesthesia caused a moderate but significant increase of TAT values at 10 min after extubation. No significant change in d-dimer levels was seen. Presuming a minimal effect of the surgical procedure on the determined variables, we conclude that none of the anaesthetic procedures induces platelet activation and fibrinolysis. The clinical relevance of the moderate coagulation activation during balanced anaesthesia remains to be investigated.

Interrelation between peripheral platelet count and platelet activation during and after liver surgery in pigs

“…As general anesthesia by itself does not induce a drop in peripheral platelet count or platelet activation [32], so these results suggest that the early acute thrombocytopenia during the operation may be either related to elevated plasma level of PF-4 released from platelets in consequence to PAF released at site of injury or to disseminated intravascular coagulation and platelet trapping. Our results are not in agreement with those of Kaneko et al [33] who found that platelet number did not change significantly during the operative period and in agreement with DelGaudio and Martinez [34] who reported that preoperative use of platelets is necessary and postoperative blood products may be required.…”

Comparison of hypotensive epidural anaesthesia and spinal anaesthesia on blood loss and coagulation during and after total hip arthroplasty Note

“…After hip arthroplasty D‐dimer concentrations have been shown to be increased mainly because of the surgical trauma ( 22). The postoperative increase in D‐dimer concentrations may reflect the severity of the surgical trauma because minimal surgical interventions do not cause any significant change in D‐dimer concentration ( 23). In this study the surgical trauma was approximately the same in all patients and, therefore, the observed difference in D‐dimer concentration between the groups may reflect lower consumption of coagulation factors and lower blood loss in the HEA group.…”

Fibrinolytic Response to Retinal Detachment Surgery under General or Local Anesthesia

“…Anesthetic agents and techniques can influence the hemostatic response to surgery through a number of mechanisms: the membrane-stabilizing effects of local anesthetics, the direct cellular effects of volatile anesthetics, the modification of the neuroendocrine response to surgery (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). It is difficult to distinguish the influence of anesthesia from that of surgery alone.…”

“…Possible anesthesia-induced changes in coagulation and fibrinolysis have been investigated and there are reports of activation of the coagulation system during different surgeries under general anesthesia (9,15). These studies, however, cannot exclude a major influence of the surgical procedure on the activation of the hemostatic system.…”