A conundrum: general or neuraxial anesthesia and the use of ROTEM.
We report the use of rotational thromboelastometry (ROTEM) to guide the management of a 29-year-old primigravida at 36weeks' gestation with portal hypertension, esophageal varices, suspected pseudocholinesterase deficiency, and steroid refractory thrombocytopenia presenting to labor and delivery with worsening peripheral edema and new-onset hypertension. A multidisciplinary decision for preoperative platelet transfusion and cesarean delivery under spinal anesthesia was made, guided by ROTEM. A successful cesarean delivery was performed with no bleeding complications.
Department of Anesthesiology, Duke University Medical Center, Box 3094, Mail Sort #10, Durham, NC 27710, USA. Electronic address: Amy.mauritz@duke.edu.
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Mauritz
Department of Anesthesiology, Duke University Medical Center, Box 3094, Mail Sort #10, Durham, NC 27710, USA. Electronic address: zaneta.strouch@duke.edu.
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Strouch
Department of Anesthesiology, Duke University Medical Center, Box 3094, Mail Sort #10, Durham, NC 27710, USA. Electronic address: Adeyemi.olufolabi@duke.edu.
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Olufolabi
D000328:Adult; D000768:Anesthesia, General / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D011247:Pregnancy; D013916:Thrombelastography / Q000379:methods*; D013921:Thrombocytopenia / Q000517:prevention & control*
Platelets; Pregnancy; ROTEM; Rotational thromboelastometry; Spinal; Thrombocytopenia