Platelet activation in major surgical stress: influence of combined epidural and general anaesthesia

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Abstract
Platelets are activated in surgery releasing vasoactive substances such as serotonin and thromboxane. Platelets become temporarily hypoaggregable during surgery followed by a postoperative hyperaggregability. Local anaesthetics are known to inhibit platelet function but earlier reports are conflicting. In order to study the impact of the combined use of general and regional anaesthesia on platelet function during major surgery 16 otherwise healthy patients were randomised to either general anaesthesia (GA) (n = 8) or GA combined with epidural anaesthesia (GA + EPI) (n = 8) for elective upper abdominal surgery. Cyclic 3′5′adenosine monophosphate, plasma glucose, plasma Cortisol and the rate pressure product (RPP) were markers of the stress response. ADP–induced platelet aggregation and the release products β‐thromboglobulin, serotonin and thromboxane 2 were measured in plasma before and during as well as for 3 days after surgery.