Effect of general and epidural anesthesia on hemostasis and fibrinolysis in hepatic patients

• Published in: Hematology (Luxembourg) Vol. 15; no. 5; pp. 360 - 367
• Main Authors: Khafagy, Hanan F., Hussein, Nadia A., Radwan, Khalda G., Refaat, Ahmed I., Hafez, Hoda S., Essawy, Fayza M., Kamel, Hend H.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.10.2010
• Subjects: Adult; Amides - administration & dosage; ANESTHESIA; Anesthesia, Epidural - methods; Anesthesia, General - methods; Anesthetics, Inhalation - administration & dosage; Anesthetics, Local - administration & dosage; EPIDURAL; Female; Fibrin Fibrinogen Degradation Products - analysis; Fibrinolysis - drug effects; Hemoglobins - analysis; HEMOSTASIS; Hemostasis - drug effects; HEPATIC; Humans; Isoflurane - administration & dosage; Liver Diseases - blood; Male; Middle Aged; Partial Thromboplastin Time; Plasminogen Activator Inhibitor 1 - blood; Platelet Count; Prothrombin Time; Thrombin Time; Time Factors; Tissue Plasminogen Activator - blood; Urinary Bladder Calculi - surgery
• ISSN: 1607-8454; 1607-8454
• DOI: 10.1179/102453310X12647083620886

This study was designed to compare the effect of general anesthesia using isoflurane and epidural anesthesia using ropivacaine on hemostasis in hepatic patients. Sixty patients were randomly allocated into two groups to receive either general or epidural anesthesia which further subdivided into control and hepatic subgroups. Blood samples were collected preoperatively, immediate post-operatively and on third post-operative day to measure hemoglobin (Hb), platelet count (PLT),), prothrombin time (PT), partial thromboplastin time (PTT), and thrombin time (TT). Specific hemostatic and fibrinolytic parameters were also included; von Willebrand factor (vWF), soluble platelet selectin (sP-selectin), prothrombin fragment (PF 1+2 ), tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1) and D-dimer. Hemoglobin showed a significant post-operative decrease in all subgroups. Post-operative changes of PLT, PT, PTT and TT were comparable between general and epidural anesthesia. General anesthesia showed a marked significant increase in specific parameters compared to epidural anesthesia. This study concluded that epidural ropivacaine anesthesia provided better hemostatic stability especially in hepatic patients.