Dynamics of perioperative changes in hemostatic potential according to low-frequency piezoelectric thromboelastography data in open transvesical prostatectomy under epidural analgesia

Abstract

Background. The anesthetic technique of choice for urological surgeries is a controversial issue, especially for transvesical prostatectomy for patients with benign prostatic hyperplasia (BPH). Often, epidural anesthesia and analgesia are considered as the methods of choice. However, the effect of an anesthetic support on perioperative changes in hemostatic potential has been poorly studied.
 Aim. The aim of the study was to demonstrate the dynamics of changes in the system of the aggregate blood state regulation by using an instrumental method, a low-frequency piezoelectric thromboelastography (LFPTEG), in the perioperative period for patients with BPH who will undergo transvesical prostatectomy.
 Material and methods. The state of the hemostatic system in a group of 71 patients with confirmed BPH who required a transvesical prostatectomy was evaluated by the APC ARP-01M Mednord device at the time of the admission, 30 min after the effect of an epidural anesthesia, an hour after the end of a surgery and a day after a surgery.
 Results. A perioperative dynamic monitoring of the state of a hemostatic balance showed that a preoperative hypercoagulation, compensated by an increased fibrinolysis, was replaced by a normocoagulation at the moment of a surgery, which was observed in the first hour after the end of a surgery and retained until the end of the first day.
 Conclusion. Hypercoagulation was found out for patients with BPH before a transvesical prostatectomy that was masked by an activation of the fibrinolytic system. The hemostatic potential assumed values identical to the reference values that should be taken into account prescribing a postoperative thromboprophylaxis against the background of a prolonged epidural blockade. The APC ARP-01M Mednord device allows you to assess all parts of a hemocoagulation at each stage of a perioperative treatment quickly and without high material costs.