engleski

Coagulopathies in Patients after Transurethral Resection of the Prostate : Spinal Versus General Anaesthesia

Transurethral resection of the prostate (TURP) is at high risk for intra- and postoperatory bleeding, due both to surgical trauma and to release of urokinase, and tissue type plasminogen activator (t-PA). The aim of this prospective observational study was to evaluate the activation of coagulopathy comparing standard laboratory values such as aPTT, PT, fibrinogen and platelet count in spinal and general anaeshesia. 45 patients, aged 62 ± 5 years (BMI: 26.3 ± 3.2), 30 undergoing transurethral resection of the prostate (TURP) in Croatian University Hospitals Zagreb under spinal anaesthesia with Levobupivacaine and 15 patients under general anesthesia with Sevorane were prospectively included. Blood samples were taken before surgery (T1) and 4 hours after end of surgery (T2). No significant changes in PT and PTT values were observed at any time. Median (range) platelet count decreased from 214 x103/µ l (145 - 661 x103/µ l) to 174 x103/µ l (140 - 561 x103/µ l) (p < 0.001).in both of anaesthesia. Fibrinogen increased in general anaesthesia 20% . Amide local anaesthetics inhibit platelet function and Levobupivacaine may decreases clot strength. Standard coagulation parameters such as PT and PTT are not suited to predict changes in the coagulation state during or after TURP. However, we failed to observe a significant activation of fibrinolysis during TURP removal possibly related to intraoperative t-PA release. Subsequent activation of fibrinolysis was consistent with normal postoperative course. References: Brueckner S, at al.. J Clin Anesth 2003 ; 15:433-40 Bew SA, at al.. Br J Anaesth 2001 ; 86:230-5

TURP; spinal anaesthesia; general anaesthesia

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