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ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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3/2017
vol. 12
 
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VSJ Competition, 2nd place
abstract:
Original paper

Comparison of the effects of spinal epidural and general anesthesia on coagulation and fibrinolysis in laparoscopic cholecystectomy: a randomized controlled trial

Suleyman Demiryas
,
Turgut Donmez
,
Vuslat Muslu Erdem
,
Duygu Ayfer Erdem
,
Engin Hatipoglu
,
Sina Ferahman
,
Oguzhan Sunamak
,
Lale Yoldas Zengin
,
Ahmet Kocakusak

Videosurgery Miniinv 2017; 12 (3): 330–340
DOI: https://doi.org/10.5114/wiitm.2017.70249
Online publish date: 2017/09/25
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Introduction: Laparoscopic cholecystectomy (LC) is usually performed under general anesthesia. Recently, laparoscopic cholecystectomy under regional anesthesia has become popular, but this creates a serious risk of thromboembolism because of pneumoperitoneum, anesthesia technique, operative positioning, and patient-specific risk factors.

Aim: This randomized controlled trial compares the effects of two different anesthesia techniques in laparoscopic cholecystectomy on coagulation and fibrinolysis.

Material and methods: This randomized prospective study included 60 low-risk patients with deep vein thrombosis (DVT) who underwent elective LC without thrombo-emboli prophylaxis. The patients were randomly divided into two groups according to the anesthesia technique: the general anesthesia (group 1, n = 30) and spinal epidural anesthesia (group 2, n = 30) groups. Measurement of the prothrombin time (PT), thrombin time (TT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), and blood levels of D-dimer (DD) and fibrinogen (F) were recorded preoperatively (pre), at the first hour (post 1) and 24 h (post 24) after the surgery. These results were compared both between and within the groups.

Results: The mean age was 51.5 ±16.7 years (range: 19–79 years). Pneumoperitoneum time was similar between group 1 (33.8 ±7.8) and group 2 (34.8 ±10.4). The TT levels significantly declined postoperatively in both groups. The levels of PT, aPTT, INR, D-dimer and fibrinogen dramatically increased postoperatively in both groups.

Conclusions: While there was not any DVT, there was a significant decline in TT. There was a dramatic rise in the PT, INR, D-dimer, fibrin degradation products (FDP), and fibrinogen following LC. This may be attributed to the effects of pneumoperitoneum and anesthesia techniques on portal vein flow.

keywords:

general anesthesia, laparoscopic surgery, fibrinogen
  
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