British Journal of Anaesthesia, Vol 79, Issue 1 29-34, Copyright © 1997 by The Board of Management and Trustees of the British Journal of Anaesthesia
N. E. Sharrock, G. Go, P. Williams-Russo, S. B. Haas and P. C. Harpel
Extradural anaesthesia is associated with lower incidences of deep vein
thrombosis after total knee arthroplasty. It is not known if the type of
anaesthesia influences thrombogenesis or fibrinolysis during knee surgery
performed under tourniquet. We studied 31 patients allocated randomly to
receive either extradural or general anaesthesia for primary unilateral
total knee arthroplasty performed under tourniquet. Radial artery blood
samples were obtained before surgery, during surgery with the tourniquet
inflated and on deflation of the tourniquet. Plasma samples were assayed
for markers of thrombin generation and fibrinolysis. Two of the circulating
indices of thrombin generation, fibrinopeptide A and thrombin-antithrombin
complexes, increased to a similar degree in the perioperative period in
both groups. Fibrinolytic activity was similar in both groups, as measured
by tissue plasminogen activator (t-PA) antigen, t-PA activity, t-PA-
plasminogen activator inhibitor complexes, alpha 2-plasmin inhibitor-
plasmin complexes and D-dimer. Extradural and general anaesthesia did not
result in significant differences in either thrombin generation or
fibrinolytic activity during total knee arthroplasty performed under
tourniquet.
CLINICAL INVESTIGATIONS
Comparison of extradural and general anaesthesia on the fibrinolytic response to total knee arthroplasty
Department of Anaesthesiology, Hospital for Special Surgery, Cornell University Medical College, New York, USA; Department of Internal Medicine, Hospital for Special Surgery, Cornell University Medical College, New York, USA; Department of Orthopaedic Surgery, Hospital for Special Surgery, Cornell University Medical College, New York, USA; Division of Hematology, Mount Sinai School of Medicine, New York, USA
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