title: Pre-, intra- and post-operative plasma levels of soluble P-selectin in diabetics under thoracic paravertebral block versus general anaesthesia.
abstract: Platelet activation that occur after tissue injury increases the expression of P-selectin. General anaesthesia and surgery may lead to peri-or post-operative hypercoagulability state that may lead to thrombotic complications, especially in high risk patients as diabetics. Administration of local anaesthesia was suggested to limit this hypercoagulability. The aim of this work was to evaluate the pre-, intra-and postoperative plasma levels of soluble P-selectin, as a predictor of thrombotic events, in diabetics receiving paravertebral block versus general anaesthesia during mastectomy operation for cancer breast. Forty type-2 diabetic females were included. They were randomly divided into two equal groups: group I received general anaesthesia and group II received thoracic paravertebral block. All females were subjected to preoperative thorough clinical examination, electrocardiography and laboratory investigations including complete blood picture, prothormbin activity, glycated hemoglobin A1c, fasting plasma levels of glucose, creatinine, lipid profile and alanine aminotransferase activity. Creatine kinase (CK), total and CK-MB, activities were also done preoperatively and six hours postoperatively. Plasma soluble(s) P-selectin levels were estimated preoperatively, 15 minutes after skin incision and one hour postoperatively. The results revealed that the preoperative plasma P-selectin levels did not significantly differ in the two groups. Its intra-and postoperative levels showed significantly higher levels in both groups than those preoperative, but the increase in group II is significantly less than those in group I. In conclusion, in high risk patients as diabetics undergoing major surgery, the use of paravertebral block is preferable as a good and effective alternative to general anaesthesia, to reduce the possibility of occurrence of thrombotic complications.
authors: Department of Anaesthesia & Surgical Intensive Care, Medical Research Institute, Alexandria University, Alexandria.
authors: N
authors: N
authors: Megahed
authors: H
authors: H
authors: Basha
authors: Sh
authors: Sh
authors: Abdel Hamid
authors: A
authors: A
authors: Ali
authors: H
authors: H
authors: El-Banawy
mesh_terms: D000768:Anesthesia, General / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods; D001943:Breast Neoplasms / Q000097:blood / Q000150:complications / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D019007:P-Selectin / Q000097:blood*; D011184:Postoperative Period
chemical_list: D019007:P-Selectin