Korean J Anesthesiol.  2003 Feb;44(2):265-270. 10.4097/kjae.2003.44.2.265.

Coagulopathy Detected with a Thrombelastography during ANH after Induction of General Anesthesia: A case report

• Jeong YS
• Choi CS
• Kim K
• Lee Y
• Yon JH

• KMID: 1936002
• DOI: http://doi.org/10.4097/kjae.2003.44.2.265

Abstract

Thrombelastography (TEG) performed by an anesthesiologist provides a rapid assessment of coagulation at the bedside. TEG analyzing coagulation status of native whole blood is a more accurate test with a relatively good sensitivity and specificity than PT and aPTT. We experienced an unexpected coagulopathy during the perioperative period. The case was a 47-year-old male patient with blood type O who underwent elective spine surgery. Perioperative coagulation tests (PT, aPTT, BT, CT, etc.) were within normal limits. Anesthesia was induced with propofol 90 mg, vecuronium 8 mg and alfentanil 0.5 mg and maintained with 1.0 1.5 vol% enflurane and 50% N2O in O2. Then we performed acute normovolemic hemodilution (ANH) with monitoring pre- and post-hemodilutional TEG. Hemostasis was revealed as abnormal by a pre-hemodilution TEG (CI = -11.06) and post-hemodilution TEG (CI = -13.06). We managed this coagulopathy with blood components and drugs on the basis of a follow-up TEG so that abnormal hemostasis and TEG findings improved (CI = -4.35). We report a case where undetected coagulopathy was revealed and treated successfuly with TEG.

Keyword

Coagulation test; coagulopathy; thrombelastography

MeSH Terms

Alfentanil
Anesthesia
Anesthesia, General*
Enflurane
Follow-Up Studies
Hemodilution
Hemostasis
Humans
Male
Middle Aged
Perioperative Period
Propofol
Sensitivity and Specificity
Spine
Thrombelastography*
Vecuronium Bromide
Alfentanil
Enflurane
Propofol
Vecuronium Bromide