The Greek e-journal of Perioperative Medicine

3-15

Authors: Varvarousi G, Klimi P, Stamatakis E, Saiti A, Iliopoulou Ch, Papa M, Scandalou V, Valsamidis D.

Obstetric haemorrhage is the leading cause of mortality in parturients. In massive haemorrhage, fibrinogen is the first coagulation factor to decrease and a value < 2 gr/lt is a prognostic indicator of severe haemorrhage. A small decrease in fibrinogen leads to an increased effect on coagulability and continued haemorrhage. Coagulation disorders may be due to either consumption of coagulation factors or dilution. The type, severity and time of onset of the coagulation disorder depend on both the size and the cause of the haemorrhage. Early recognition of the cause of haemorrhage, low fibrinogen and its immediate correction are essential in the perioperative management of haemorrhage. The use of viscoelastic coagulation measurements contributes to rapid, individualized and targeted management of haemorrhage and coagulation disorders. It reduces transfusion of blood products and their complications, the length of hospital stay and in-hospital mortality. In obstetric haemorrhage, the target is haemoglobin > 8 gr/dl. Fibrinogen should be greater than 2g/L and replaced with cryoprecipitate or fibrinogen concentrate. Replacement of fibrinogen by plasma will lead to administration of large amounts of plasma and increase the risk of complications. Platelet count should be > 75 X100/l. Their administration is indicated in pre-existing thrombocytopenia, coagulation disorder from consumption and blood loss > 5000 ml. At the same time, it is important to avoid acidosis, hypocalcaemia and hypothermia.

55-61

Authors: Çağla Yazar, Nedim Çekmen

Thoracic epidural anaesthesia (TEA) is frequently used for anaesthesia and analgesia in today’s practice. Although cholecystectomy is a surgical procedure performed under general anaesthesia (GA), many studies in recent years have shown that neuraxial techniques can be used safely. We aimed to present the anaesthesia management under dexmedetomidine sedation with TEA in high-risk patients who underwent laparoscopic cholecystectomy surgeries. Both patients were of geriatric age and had several comorbidities. In patients, we preferred TEA to avoid the cardiorespiratory effects of GA. Preoperative preparation of patients with a multidisciplinary approach, cooperation, and close follow-up is essential in preventing complications.