Perioperative effect of general and combined (general plus epidural) anesthesia on coagulation parameters of surgical cancer patients[Greek]
Authors: Vasiliadis M , Mitragas A, Konstantinidou A, Markala D, Kaplanis K
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Perioperative hypercoagulation in cancer patients is frequently a concern for the anesthesiologist. Ιt is not clarified yet whether the choice of anesthetic technique offers significant advantages for the prevention of postoperative complications. For this purpose, a prospective, randomized clinical trial was conducted. Forty-two female patients with ovarian cancer, undergoing abdominal hysterectomy, were randomized in three groups. In the first group, 19 patients received general anesthesia, in the second group 18 patients received combined anesthesia, in particular general anesthesia with epidural administration of local anesthetic and in the third group 15 patients also received combined anesthesia, but with epidural administration of opioids. The following parameters were measured: Hemoglobin, platelet count, prothrombin time, INR (International Normalised Ratio), activated partial-thomboplastin time, fibrinogen, D-Dimers, antithrombin III, protein C and resistance to activated protein C. Four blood samples were taken: 1st) preoperatively, 2nd) in the Post-Anesthetic Care Unit, 3rd) twenty-four hours and 4th) forty-eight hours postoperatively. No statistical difference was observed among the groups in all parameters. In the second postoperative day, an increase of fibrinogen (p<0.01) and of D-Dimers (p<0.001) was observed. It seems that either general anesthesia or combined anesthesia (general anesthesia with epidural local anesthetics or opioids) influence these certain coagulation parameters in the same manner in cancer patients. An increase of fibrinogen and of D-Dimers was observed in the second postoperative day in the patients of all groups.