title: Intravenous ketorolac tromethamine does not worsen platelet function during knee arthroscopy under general anesthesia.
abstract: Ketorolac (KT) prolongs bleeding time and inhibits platelet aggregation and platelet thromboxane production in healthy, awake volunteers. However, platelet function may be accentuated during the stress of general anesthesia (GA) and surgery. The purpose of this study was to investigate platelet function changes during a standard GA technique and surgery, as well as after a single intraoperative dose of intravenous (i.v.) KT. The study comprised 30 ASA physical status I patients undergoing GA for knee arthroscopy. Subjects were randomized to receive either KT 60 mg IV 15 min after skin incision or placebo i.v. Platelet function testing consisted of an Ivy bleeding time (BT), platelet aggregometry (PA) with adenosine diphosphate (ADP) and collagen, thromboelastography (TEG), and serum thromboxane B2 assays (TxB2). Platelet function testing was performed: 1) 15 min prior to the induction of GA, 2) 10 min after skin incision, and 3) 45 min after administration of study drug. BT decreased significantly in the placebo group from 263 +/- 133 s (mean +/- SD) preoperatively to 207 +/- 89 s postincision. BT did not change in the KT group. PA was unchanged after IV KT. TEG data was unchanged in both groups during anesthesia and surgery. TxB2 levels decreased markedly in the KT group from 106.9 +/- 96.2 ng/mL preoperatively to 0.4 +/- 1.2 ng/mL poststudy drug, P = 0.002. Platelet function appears to be accentuated during GA and surgery as evaluated by BT in the placebo group. Further, platelet function by BT, PA, and TEG was not inhibited after i.v. KT despite near complete abolition of TxB2 production.
authors.affiliation: Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas 78234-6345, USA.
authors.forename: B K
authors.initials: BK
authors.lastname: Thwaites
authors.forename: D B
authors.initials: DB
authors.lastname: Nigus
authors.forename: G W
authors.initials: GW
authors.lastname: Bouska
authors.forename: P D
authors.initials: PD
authors.lastname: Mongan
authors.forename: E F
authors.initials: EF
authors.lastname: Ayala
authors.forename: G A
authors.initials: GA
authors.lastname: Merrill
mesh_terms: D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000494:pharmacology*; D000768:Anesthesia, General; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000494:pharmacology*; D001182:Arthroscopy; D001777:Blood Coagulation / Q000187:drug effects; D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D020911:Ketorolac Tromethamine; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010919:Placebos; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D011446:Prospective Studies; D016037:Single-Blind Method; D013916:Thrombelastography; D013929:Thromboxane B2 / Q000037:antagonists & inhibitors / Q000097:blood; D014046:Tolmetin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D014325:Tromethamine / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D010919:Placebos; D010975:Platelet Aggregation Inhibitors; D014325:Tromethamine; D020911:Ketorolac Tromethamine; D013929:Thromboxane B2; D014046:Tolmetin