title: The effect of epidural/general and cervical plexus block anesthesia on activated clotting time in patients undergoing vascular surgery.
abstract: The effect of anesthetic induction and surgical incision on activated clotting time (ACT) was determined in patients undergoing vascular surgery. Patients undergoing carotid endarterectomy (CAE) (n = 50) and abdominal aortic aneurysm repair (AAA) (n = 45) were studied. Patients in the CAE group had cervical plexus block anesthesia, whereas patients in the AAA group had a combination of epidural and general anesthesia. The ACT was measured 1) before induction of anesthesia, 2) 5 min after induction, 3) 5 min after incision, 4) 5 min after heparinization, and 5) at the onset of skin closure. Heparin was reversed with protamine only if the ACT after revascularization was > 200 s. Reversal was considered adequate if the ACT was < 200 s and the surgeon felt that hemostasis was adequate. The ACT decreased by 12.26 +/- 1.23 (mean +/- SE) (P = 0.006) in the CAE group and by 12.47 +/- 1.01 (P = 0.002) in the AAA group with induction of anesthesia. There was a further decrease of 5.06 +/- 0.62 (P = 0.26) in the CAE group and 5.17 +/- 0.83 (P = 0.22) in the AAA group with incision. There was a significant difference in ACT in both groups from postinduction and postincision to skin closure (higher at skin closure). No patient in either group required additional protamine or clotting factors post-operatively, or return to the operating room for excessive bleeding. This study demonstrates that anesthetic induction with cervical block or epidural/general anesthesia decreases ACT.(ABSTRACT TRUNCATED AT 250 WORDS)
authors: Department of Anesthesiology, NYU Medical Center, NY 10016.
authors: M S
authors: MS
authors: Gold
mesh_terms: D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D017544:Aortic Aneurysm, Abdominal; D002572:Cervical Plexus; D004305:Dose-Response Relationship, Drug; D016894:Endarterectomy, Carotid; D005069:Evaluation Studies as Topic; D006801:Humans; D009407:Nerve Block; D011479:Protamines / Q000008:administration & dosage; D014914:Whole Blood Coagulation Time
chemical_list: D011479:Protamines