Intraoperative coagulation monitoring and small bowel transplantation: a way to explore.
BACKGROUND
The existence of coagulation disorders during intestinal transplantation is getting more important for a correct anesthetic management. Both a condition of hypocoagulation and hypercoagulation can happen during the intraoperative course. Thromboelastography (TEG), a test on whole blood coagulation, allows measurement of different phases of coagulation function. The aims of our study were to evaluate coagulation derangements during bowel transplantation using TEG.


METHODS
We measured cold ischemia time in 19 patients who underwent general anesthesia for intestinal transplantation. We measured five TEG indicators (R, K, angle, MA, CL50) at defined intervals: dissection phase (T1), vascular anastomosis phase (T2), 30' (T3) and 120' (T4) after reperfusion during the intestinal reconstruction.


RESULTS
We found a statistically significant difference between MA measured at T1 versus T3 and T4. There was no significant relation between MA derangements and ischemia time.


CONCLUSIONS
Patients showed hypocoagulation pattern during all periods. MA indicator variation between the initial value and the value after reperfusion may relate to release of hypocoagulation factors. We observed important coagulation derangements during small bowel transplantation, particularly on platelet function after graft reperfusion. The derangements did not depend on ischemia time.
Piraccini
E
E
Department of Anesthesiology, Liver and Multiorgan Transplant Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
Zanzani
C
C
Caporossi
E
E
Siniscalchi
A
A
Dante
A
A
Serri
T
T
Faenza
S
S
D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical; D006801:Humans; D007421:Intestine, Small / Q000637:transplantation*; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000628:therapy; D016343:Monitoring, Intraoperative / Q000379:methods*; D015424:Reperfusion; D012189:Retrospective Studies