Per‐ and postoperative changes in coagulation and fibrinolytic variables during abdominal hysterectomy under epidural or general anaesthesia

Abstract

Blood coagulation and fibrinolysis were studied in 20 premenopausal women undergoing abdominal hysterectomy under general anaesthesia (GA) or high epidural analgesia (EDA). As expected, the adrenocortical stress response was suppressed in the EDA group. The Factor VIII complex (F VIII:C, F VIII R:Ag = von Willebrand factor), known to be related to adrenocortical activity and/or vessel wall reactivity, was found to increase less in the EDA group. With regard to all the other variables analysed there were no significant differences between the groups. With both anaesthetic procedures activation of coagulation could be demonstrated by a decrease in prekallikrein, F X and antithrombin as well as by an increase in fibrinopeptide A levels. A decrease in plasminogen and alpha 2-antiplasmin suggested activation of the fibrinolytic system and a decrease in prekallikrein and kallikrein inhibition activity (C-1-esterase inhibitor) an activation of the kallikrein system. In this study only the differences in F VIII complex could explain the previously reported higher thromboembolic frequency after GA as compared to EDA.

Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised

“…Ten studies were excluded because they were quasi-randomised,8-17 and six were excluded because not all participants were randomised and separate information on the randomised patients was not available 18-23. One trial was excluded because the groups differed with respect to heparin treatment as well as anaesthetic technique 24.…”

Activation of cascade systems by hip arthroplasty: No difference between fixation with and without cement

“…Epidural analgesia (EDA) lowers the incidence of postoperative thrombosis (Modig et al 1981) and attenuates the Factor VIII-complex response to surgical stress (Modig et al 1983, Bredbacka et al 1986). …”

“…Venous blood samples were collected by direct venipuncture of a cubital vein using a sharp 1.4 mm needle and without stasis on the forearm, as earlier described (Bredbacka et al 1986). The samples were collected on the day before surgery (Day -I), during surgery, i.e., 10 minutes after insertion of the femoral component (Day 0), the first (Day 1).…”

The effectiveness of local anesthetics in preventing postoperative adhesions in rat models

“…It has also been shown that local anesthetics activate the fibrinolytic system, reduce factor VIII, plasminogen and alfa-2-antiplasmin concentration, and inhibit platelet aggregation [9,10]. We therefore designed a study to determine whether the application of local anesthetics to the intraperitoneal space following surgery might be able to prevent intraabdominal adhesions.…”