Baseline Activated Coagulation Time Should Be Measured After Surgical Incision

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Abstract
Ardiopulmonary bypass. Results vary in previous comparisons of baseline ACT to postprotamine ACT, with some showing postprotamine ACT significantly below baseline values. The present study examined ACTs at three possible baseline intervals in 68 patients at two institutions: (a) before anesthetic induction; (b) after anesthetic induction; and (c) after sternotomy. Baseline ACT decreased significantly with anesthesia and surgery. The poststernotomy baseline ACT best matched the postprotamine ACT. It appears likely that surgery induces a throm-boplastic response that decreases ACT. Establishing baseline ACT before anesthetic induction would predispose to false diagnoses of adequate protamine neutralization after cardiopulmonary bypass, because ACT is relatively insensitive to low concentrations of unneutralized heparin. Baseline ACTs should therefore be measured after surgical incision Address correspondence to Dr. Gravlee, Department of Anesthesia, Wake Forest University Medical Center, 300 South Hawthorne Road, Winston-Salem, NC 27103 Presented in part at the April 1989 annual meeting of the Society of Cardiovascular Anesthesiologists, Seattle, Washington. Accepted for publication July 25, 1990. © 1990 International Anesthesia Research Society...