Sage Journals: Discover world-class research

Abstract

Purpose

To evaluate perioperative changes in fibrinolysis in patients undergoing retinal detachment surgery under general or local anesthesia.

Patients

Prospective study of 81 patients (43 male, 38 female), aged from 15 to 82 (mean 50.7 SD = 17.8) years, undergoing retinal detachment surgery (encirclement with scleral buckling) under general anesthesia (group A), and 14 patients (6 male, 8 female) aged from 15 to 78 (mean 52.9, SD =19.8) years, operated under local anesthesia (group B). Excluded were patients with venous or arterial disease or other factors that could change the parameters investigated.

Methods

Blood was sampled from a cubital vein one day before surgery, immediately after induction of anesthesia but before surgery, immediately after completion of the operation but before the termination of anesthesia and after the operation (on days 1 and 4). In patients' citrated plasma, tissue plasminogen activator antigen (t-PA-Ag), plasminogen activator inhibitor type 1 antigen (PAI-1 Ag) and activity (PAI-1), fibrin-fibrinogen degradation products (FDP) and euglobulin lysis time (ELT) were measured.

Results

The pattern of changes in perioperative fibrinolytic activity was similar in both groups. Intraoperative levels of FDP were significantly higher and ELT shorter than preoperatively. In both groups t-PA Ag concentration was significantly increased on the first postoperative day. There were no changes in PAI-1 in both groups. Postoperatively, the FDP concentration was reduced and ELT prolonged.

Conclusions

Retinal detachment surgery induces intraoperative activation of fibrinolysis in the systemic circulation regardless of the type of anesthesia.

Keywords

Fibrinolysis Retinal detachment surgery Anesthesia Tissue plasminogen activator and inhibitor

Get full access to this article

View all access options for this article.

References

Murphy

W.G.

, Davies

M.J.

, Eduardo

. The haemostatic response to surgery and trauma. Br J Anaesth 1993; 70: 205–13.

Malukiewicz-Wiśniewska

, Kotschy

, Kaluzny

. The influence of retinal detachment surgery on perioperative blood fibrinolysis. Curr Eye Res 1999; 19: 123–30.

Mansfield

A.O.

. Alteration in fibrinolysis associated with surgery and venous thrombosis. Br J Surg 1972; 59: 754–7.

Kominger

, Speiser

, Wojta

, Binder

B.R.

. Sandwich ELISA for t-PA antigen employing a monoclonal antibody. Thromb Res 1986; 41: 527–35.

Ranby

, Nguyen

, Scarabin

P.Y.

, Samana

. Immunoreactivity of tissue plasminogen activator and it's inhibitor complexes: Biochemical and multicenter validation of a two site immunosorbent assay. Thromb Haemost 1989; 61: 409–14.

Chmielewska

, Wiman

. Determination of tissue plasminogen activator and its fast inhibitor in plasma. Clin Chem 1986; 32: 482–5.

Merskey

, Zalezari

, Johnson

A.J.

. A rapid, simple, sensitive method for measuring for fibrinolytic split-products in human serum. Proc Soc Exp Biol Med 1969; 131: 871–9.

Kowarzyk

, Buluk

. Postepy badan nad krzepnieciem krwi. Postepy Hig Med Dosw 1950; 2: 1–9.

Bredbacka

, Blomback

, Hagnevik

, Irestedt

, Raabe

. Per- and postoperative changes in coagulation and fibrinolytic variables during abdominal hysterectomy under epidural or general anaesthesia. Acta Anaesthesiol Scand 1986; 30: 204–10.

10.

Davis

F. M.

, McDermott

, Hickton

Influence of spinal and general anaesthesia on haemostasis during total hip arthroplasty.

Br J Anaesth 1987; 59: 561–71.

11.

Bertha

B.G.

, Folts

J.D.

, Nugent

, Rusy

B.F.

. Halothane, but no isoflurane or enflurane, protects against spontaneous and epinephrine-exacerbated acute thrombus formation in stenosed dog coronary arteries. Anesthesiology 1989; 71: 96–102.

12.

Fauss

B.G.

, Meadows

J.C.

, Bruni

C.Y.

, Qureshi

G.D.

. The in vitro and in vivo effects of isoflurane and nitrous oxide on platelet aggregation. Anesth Analg 1986; 65: 1170–4.

13.

Fyman

P.N.

, Triner

, Schranz

Effect of volatile anaesthetics and nitrous oxide-fentanyl anaesthesia on bleeding time.

Br J Anaesth 1984; 1198–200.

14.

Niemi

T T.

, Kuitunen

, Vahtera

E.M.

, Rosenberg

P.H.

. Haemostatic changes caused by i.v. regional anaesthesia with lignocaine. Br J Anaesth 1996; 76: 822–8.

15.

Loick

H.M.

, Goener-Radig

, Ostermann

, Theissen

J.L.

, Zander

. The influence of different procedures of general anaesthesia on platelet function, coagulation and fibrinolysis system. Acta Anaesthesiol Scand 1993; 37: 493–7.

16.

Rosenfeld

B.A.

, Beattle

, Christopherson

The effect of different anesthetic regimens on fibrinolysis and the development of postoperative arterial thrombosis.

Anesthesiology 1993; 79: 435–43.

17.

Sharrock

N.E.

, Go

, Williams-Russo

, Haas

S.B.

, Harpel

P.C.

. Comparison of extradural and general anaesthesia on the fibrinolytic response to total knee arthroplasty. Br J Anaesth 1997; 79: 29–34.

18.

Simpson

P.J.

, Radford

S.G.

, Forster

S.J.

, Cooper

G.M.

, Hughes

A.O.

. The fibrinolytic effects of anaesthesia. Anaesthesia 1982; 37: 3–8.

19.

Gold

M.S.

. The effect of epidural/general and cervical plexus block anaesthesia on activated clotting time in patients undergoing vascular surgery. Anesth Analg 1993; 76: 701–4.

20.

Roussi

, Andre

, Samama

Platelet functions and haemostasis parameters in pigs: absence of side effects of a procedure of general anaesthesia.

Thromb Res 1996; 81: 296–305.

21.

Mellbring

, Dahlgren

, Wiman

. Plasma fibrinolytic activity in patients undergoing major abdominal surgery. Acta Chir Scand 1985, 151: 109–14.

22.

Aramoto

, Shigematsu

, Tetsuichro

. Perioperative changes in coagulative and fibrinolytic function during surgical treatment of abdominal aortic aneurysm and arteriosclerosis obliterans. Int J Cardiol 1994; 47: 55–63.

23.

Dabrowiecki

, Rosc

, Jurkowski

. The influence of laparoscopic cholecystectomy on perioperative blood clotting and fibrinolysis. Blood Coagul Fibrinolysis 1997; 8: 1–5.

24.

Kluft

, Verfheijen

J.H.

, Jie

A.F.H.

The postoperative fibrinolytic shutdown a rapidly reverting acute phase pattern for the fast acting inhibitor of tissue-type plasminogen activator after trauma.

Scand J Clin Lab Invest 1985; 45: 605–10.