ABSTRACT
BACKGROUND AND OBJECTIVES: Deficiency in protein S, which is a glycoprotein with anticoagulant activity, increases the risk for thromboembolic events. This report aimed at addressing anesthetic management of protein S deficient obstetric patient. CASE REPORT: Protein S deficient patient, at 25 weeks gestation, presented the following lab results: INR = 0.9, TTPA = 32 s (control 25.6), protein S = 35% (normal = 70% to 130%). In the last three gestation quarters she has received up to 12,000 IU heparin every 8 hours. With 38 weeks, she was admitted in labor. After 8 uninterrupted heparin hours, already with TTPA of 25.8 s (control 27.8 s) epidural anesthesia was induced with 6 ml of 0.2% bupivacaine and fentanyl (20 microg), followed by continuous infusion. Infusion time was 5 hours with total 40 mg bupivacaine dose. There have been no intercurrences and 1 hour after catheter removal, subcutaneous 10,000 IU heparin were restarted at 12-hour intervals. Patient and neonate evolved well and were discharged 3 days later. CONCLUSIONS: Protein S deficient pregnant patients should receive anticoagulants to maintain TTPA twice the control value. Heparin, for not crossing placental barrier, is the anticoagulant of choice in obstetrics. Blockade may be induced respecting a minimum period of 4 to 6 hours between last heparin dose and lumbar puncture, provided lab tests are within normal ranges. In these cases, however, epidural analgesia may help in preventing thromboembolic events.
ABSTRACT
BACKGROUND AND OBJECTIVES: Clonidine is an a2-agonist which decreases intravenous and inhalational anesthetics consumption. This study aimed at evaluating the cost-benefit ratio of preanesthetic medication with intravenous clonidine for general anesthesia with sevoflurane in outpatient procedures. METHODS: Forty five patients aged 15 to 52 years were included in this double-blind, randomized and placebo controlled study, and were distributed in 3 groups of 15: Group S (placebo), Group C3 (3 microg kg(-) clonidine) and Group C5 (5 microg kg(-1) clonidine). Anesthesia was induced with sevoflurane, alfentanil (30 microg kg(-1)) and pancuronium (0.08 mg kg(-1)). The following parameters were recorded: incidence of complications, halogenate consumption and anesthesia duration, as well as phase I and II recovery time. Cost analysis has considered direct and indirect costs. RESULTS: There were no differences among groups in demographics data, incidence of complications and phase I anesthetic recovery. Phase II anesthetic recovery was prolonged in Group C5 (p < 0.05). Sevoflurane consumption per minute of surgery was 0.54 +/- 0.14, 0.33 +/- 0.09 and 0.34 +/- 0.13 in Groups S, C3 and C5 respectively (p < 0.05). Costs were approximately 35% lower in the clonidine groups. CONCLUSIONS: Intravenous clonidine (3 microg kg(-1)) decreases sevoflurane consumption without prolonging phase I recovery. Although decreasing sevoflurane consumption, 5 microg kg(-1) clonidine prolongs phase II recovery, thus being inadequate for outpatient procedures.