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Epidural anesthesia can protect fibrinolytic function after surgery
Author(s): 
Pages: 383-389
Year: Issue:  4
Journal: JOURNAL OF PEKING UNIVERSITY(HEALTH SCIENCES)

Keyword:  AnesthesiaepiduralAnesthesia generalHysterectomyStressBlood coagulationFibrinolysis;
Abstract: Objective :To study the influences of different anesthesia techniques on stress response, coagulation and fibrinolytic function. Methods: Thirty patients undergoing hysterectomy were randomized into three groups: Group E ( continuous epidural anesthesia, n = 10) , Group G + E ( epidural anesthesia combined general anesthesia, n = 10 ) and Group G (general anesthesia, n = 10 ). The blocking level with epidural anesthesia was maintained between T6 - L3 with 0.75% bupivacaine followed by PatientControlled Epidural Analgesia (PCEA). General anesthesia was finished with convention followed by Patient-Controlled Analgesia (PCA). Blood samples were taken at pre-anesthesia (T0 ) , the end of operation ( T1 ) and postoperative 24 h (T2 ), 72 h ( T3 ) to determine catecholamine concentration, coagulation and fibrinolysis variables. Results: The nonepinephrine (NE) levels in Group E and Group G + E were not changed throughout the procedure, but obviously elevated in Group G (P <0.01 ) as compared with the baseline and those in the other Groups ( P < 0.05 ). The epinephrine (E) levels at T1 in all groups were markedly increased as compared with those at T0 and peaked (P <0.01 ), and then returned to the baseline at T3. Fibrinogen (FIB) levels in all groups were obviously decreased at T1, postoperatively elevated rapidly and peaked at T3 (P < 0.01 ). FIB levels at T3 in groups G + E and G were much higher than that in Group E (P <0.05 ). The thrombin-anti-thrombin Ⅲ complex (TAT) levels at T1 in Group G + E and G were significantly increased as compared with those at Group E ( P < 0.01 ), and subsequently recovered to pre-anesthesia following surgery. TAT level in Group E was more decreased postoperatively than the baseline and those in the other groups (P < 0.05 ). The D-dimer level in Group E over time was remarkably increased as compared with the baseline ( P < 0.05 ), and the D-dimer levels peaked at T2 in all groups (P <0.01 ). The tissue-type plasminogen activator (t-PA) was more elevated than T0 at T1 (P <0.01 ) in all groups, and then returned to normal in Group E. But the marked decrease of t-PA in Groups G + E and G was revealed 72 h after surgery and became much lower than that in Group E (P <0.01 ). The plasminogen activating inhibitor-1 (PAI-1) in Group G and Group G + E was more elevated perioperatively and became higher than that in Group E (P < 0.01 ). Conclusion: Epidural anesthesia can preserve fibrinolytic function after lower-abdomen surgery by the inhibitory effects on surgical stress, PAI-1 and other mechanisms. The thromboprophylactic effects are revealed only following epidural anesthesia.
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