The effect of general anesthesia on hemostasis

Abstract

Background: The growing number of surgical patients requiring long-term anticoagulation or presenting with coagulopathies necessitates a precise understanding of how anesthetic induction agents affect the hemostatic system.

Objective: To evaluate the acute impact of propofol and sufentanil induction on primary and secondary hemostasis using rotational thromboelastometry (ROTEM) and flow cytometry (FC).

Methods: A prospective pilot study was conducted on 7 adult patients (ASA physical status I) scheduled for elective surgery. Blood samples were collected immediately before and 5–7 minutes after intravenous induction with propofol and sufentanil (prior to surgical incision to exclude surgical trauma influence). Hemostatic parameters evaluated included ROTEM (EXTEM/INTEM: CT, CFT, Alpha angle, MCF, A10, A20) and FC (total and activated platelet counts). Nonparametric paired data were analyzed using the Wilcoxon signed-rank test.

Results: A statistically significant increase in the EXTEM Alpha angle was observed post-induction (p = 0.047), indicating an accelerated rate of clot formation. A trend toward hypercoagulability was noted for EXTEM CFT (p = 0.063) and INTEM CT (p = 0.108). Other ROTEM parameters (MCF, A10, A20) showed no significant changes. Flow cytometry revealed less than a 5% difference in total and activated platelet counts (p > 0.50), indicating no clinically relevant alterantion of platelet function.

Conclusion: Induction of general anesthesia with propofol and sufentanil in ASA I patients exerts minimal influence on hemostasis, displaying only a slight trend toward hypercoagulability. Both agents can be safely administered without compromising perioperative coagulation dynamics.