The Effects of Different Anesthetic Regimens on Fibrinolysis and the Development of Postoperative Arterial Thrombosis

Analgesia de parto em paciente portadora de deficiência de proteína S: relato de caso

“…O parto vaginal parece ser a via de eleição, pois o risco de sangramento no parto cesariano é maior, bem como a duração do estresse e das alterações endócrino-metabólicas e imunológicas, o que poderia resultar em risco aumentado de eventos trombóticos 15 . Contudo, o estresse do trabalho de parto desencadeia resposta neuroendócrina e metabólica semelhante a do estresse cirúrgico, resultando em ativação do eixo hipotálamo-hipofisário e conseqüente estado de hipercoagulabilidade [17][18][19] . Portanto, a escolha da técnica anestésica neste caso deve objetivar, além do conforto materno e bem estar fetal, a atenuação da resposta ao do estresse do trabalho de parto.…”

“…Vaginal delivery seems to be the method of choice because bleeding risk in C-section is higher, as well as stress and endocrine-metabolic and immune changes duration, which could result in increased risk for thrombotic events 15 . However, labor stress triggers neuroendocrine and metabolic response similar to surgical stress, resulting in hypothalamohypophysial axis activation and consequent hypercoagulability [17][18][19] . So, anesthetic technique in this case should aim at maternal comfort and fetal wellbeing in addition to attenuating labor stress response.…”

Perioperative myocardial infarction in non-cardiac surgery. Pathophysiology and clinical implications

“…Major surgery and, in particular, abdominal aortic surgery are followed by extensive changes in the plasma levels of coagulation factors and in thromboelastographic parameters leading to a hypercoagulable state. An early impairment of fibrinolysis with higher amounts of plasminogen activator inhibitor-1 was observed in the early postoperative period (24 h) after infra-inguinal reconstruction 50 and in patients undergoing lowerextremity vascular reconstruction 51 and remained elevated through the second day. A return to baseline values of plasminogen activator inhibitor-1 and fibrinolysis was observed at day 3.…”

Are the recommendations to use perioperative -blocker therapy in patients undergoing noncardiac surgery based on reliable evidence?

“…A host of mechanisms, including increases in adrenergic activity, free fatty acid levels, platelet reactivity, plasminogen activator inhibitor I, factor VIII-related antigen levels, inflammation, and decreases in antithrombin III levels, probably mediate perioperative cardiovascular events. 8,[11][12][13][14] Only a few of these mechanisms (e.g., decreasing adrenergic activity and free fatty acid levels) are targeted by β-blockers. Given the number of important pathogenic mechanisms that are unaffected by β-blockers, relative risk reductions much greater than 25% are implausible.…”