title: Laparoscopic splenectomy in a pregnant patient with immune thrombocytopenic purpura.
abstract: We describe the perioperative management of a pregnant woman at 19 weeks' gestation with idiopathic thrombocytopenic purpura requiring laparoscopic splenectomy. The preoperative platelet count ranged between 1 and 5 x 10(9)/L and did not respond to conventional medical therapy. To reduce the risk of intracerebral hemorrhage, platelets were transfused before induction of anesthesia to maintain platelet count closer to 20 x 10(9)/L. The blood pressure was monitored continuously via an arterial line and remifentanil was infused to prevent a hypertensive response to induction/intubation, carbon dioxide insufflation, and surgery. After the splenic artery was clamped, additional platelet units were transfused to assure surgical hemostasis.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
authors.forename: T W
authors.initials: TW
authors.lastname: Felbinger
authors.forename: M
authors.initials: M
authors.lastname: Posner
authors.forename: H K
authors.initials: HK
authors.lastname: Eltzschig
authors.forename: B S
authors.initials: BS
authors.lastname: Kodali
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006340:Heart Rate, Fetal; D006470:Hemorrhage / Q000150:complications; D006801:Humans; D007231:Infant, Newborn; D010535:Laparoscopy; D008297:Male; D010880:Piperidines; D010976:Platelet Count; D017713:Platelet Transfusion; D011247:Pregnancy; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery*; D000077208:Remifentanil; D013156:Splenectomy
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil