British journal of anaesthesia
-
Clinical Trial Controlled Clinical Trial
Preparation for regional anaesthesia induces changes in thrombelastography.
The effects of crystalloid and colloid infusions on coagulation measured by thrombelastography (TEG) present a confused picture. The influence of environmental factors may explain the disparity between previous studies. We studied two groups of 20 women presenting at term for elective Caesarean section. ⋯ We found significant changes in r and k values in both groups, suggesting enhanced coagulation. As hypercoagulable changes were also seen in the group that did not receive fluid preload, the hypothesis that moderate haemodilution causes hypercoagulability must be questioned. The influence of environmental factors can explain differences reported between in vivo and in vitro studies.
-
Case Reports
Patient-controlled analgesia in labour using remifentanil in two parturients with platelet abnormalities.
Two term parturients with documented platelet abnormalities presented to the delivery suite in labour. Because regional analgesic techniques were contraindicated, we elected to use patient-controlled i.v. remifentanil for pain relief. ⋯ There were no adverse neonatal sequelae. If there are facilities to monitor the neonate and mother, this method of analgesia may prove useful in those patients where regional techniques are not possible, but further research is needed to ascertain its safety and appropriateness in such circumstances.