Coagulation assessment in normal pregnancy: thrombelastography with citrated non activated samples.

BACKGROUND: Thrombelastography (TEG) provides an effective and convenient means of whole blood coagulation monitoring. TEG evaluates the elastic properties of whole blood and provides a global assessment of hemostatic function. Previous studies performed TEG on native blood sample, but no data are available with citrated samples in healthy pregnant women at term. The aim of this study was to investigate the effect of pregnancy on coagulation assessed by TEG and establish normal ranges of TEG values in pregnant women at term comparing them with healthy non pregnant young women. METHODS: We enrolled pregnant women at term undergoing elective cesarean section or labour induction (PREG group) and healthy non-pregnant women (CTRL group). Women with fever or inflammatory syndrome, defined as C-reactive protein (CRP) >5 mg/L and with a platelet count <150.000/mm(3) have been excluded. For each women hemochrome and standard coagulation test were assessed. At the same time we performed a thrombelastographic test with Hemoscope TEG(®) after sample recalcification without using any activator. RESULTS: One hundred thirty patients were studied, 65 for each group. There were no differences between groups regarding demographic data. Hemoglobin, platelet count, International Normalized Ratio and Activated Partial Thromboplastin Time Ratio were lower and fibrinogen was higher in PREG group. All TEG parameters resulted as being significantly different between the groups with a hypercoagulable pattern in PREG group compared to CTRL group. CONCLUSION: The main findings of this study confirm the hypercoagulability status of pregnant women at term. This coagulation pattern is well represented by thrombelastographic trace obtained by recalcified citrate blood sample.

Sedation with ketamine during cataract surgery.

PURPOSE: To evaluate the cardiovascular and ocular effects of a low-dose sedation-analgesia regimen in cataract surgery. SETTING: Department of Ophthalmology, University of Udine, Udine, Italy. METHODS: Eighty patients were randomly assigned to two groups. The first was treated with droperidol 0.03 mg/kg, diazepam 0.06 mg/kg, ketamine 0.3 mg/kg; the second (control), with the same drugs except for ketamine. Heart rate, arterial pressure, and intraocular pressure (IOP) in the fellow eye were measured before and 3 minutes after injection of the sedative mixture. The anesthetic block was then performed. RESULTS: Heart rate increased in both groups by about 5%. Systolic arterial pressure fell by 15.6 mm Hg +/- 22.3 (SD) in the ketamine group and by 31.7 +/- 17.3 mm Hg (P < .005) in the control group. Intraocular pressure fell in the two groups by 5.24 +/- 2.8 mm Hg and 4.5 +/- 2.5 mm Hg, respectively. None of the ketamine-treated patients reported pain during the administration of anesthesia or postoperatively. Eighty percent of the control group reported pain. In the early postoperative period, no episodes of nausea, emesis, or hallucination were reported. CONCLUSION: In a regimen with other drugs, ketamine did not influence IOP and enabled comfortable completion of anesthesia and surgery.