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


METHODS
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.
Malukiewicz-Wiśniewska
G
G
Department of Ophthalmology, The Ludwik Rydygier's University School of Medical Sciences, Bydgoszcz, Poland.
Kotschy
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000772:Anesthesia, Local; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005342:Fibrinolysis / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011446:Prospective Studies; D012163:Retinal Detachment / Q000097:blood / Q000601:surgery*; D012591:Scleral Buckling; D012712:Serum Globulins / Q000378:metabolism; D010959:Tissue Plasminogen Activator / Q000097:blood
D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; D012712:Serum Globulins; D010959:Tissue Plasminogen Activator