2009, Number 1
<< Back
Rev Mex Anest 2009; 32 (1)
Thromboelastography as a decision guide for transfusional therapy in bleeding post amygdalectomy secondary to pseudo aneurysm
Raffan-Sanabria F, Amaya W, Manrique-Peñuela F
Language: Spanish
References: 15
Page: 67-71
PDF size: 240.01 Kb.
ABSTRACT
We report a case of a patient without significant medical records, who presented massive bleeding in the late post-operative period due to an amygdalectomy that caused hemodynamic instability and coagulation disorders. It was used thromboelastography on the patient as an additional tool in order to evaluate the coagulation state and the approach of a proper and different therapy from the one that had been taken when following the traditional tests (thrombin time [TT], prothrombin time [PT], platelet and fibrinogen count). An adequate hemostasis was achieved. For the definite control of the bleeding, it was practiced an arteriography and a posterior embolization of the left lingual artery with «platinum coils» secondary to the initial surgical procedure.
REFERENCES
Kozek-Langenecker S. Management of massive operative blood loss. Minerva Anesthesiol 2007;73:401-15.
Luddington RJ. Thromboelastography/thromboelastometry. Clin Lab Haem 2005:27,81-90.
Salooja N, Perry D. Thromboelastography. Blood coagulation and Fibrinolysis 2001;12:327-337.
Menauer F, Suckfull M, Stabler A, Grevers G. Pseudoaneurysm of the lingual artery after tonsillectomy. A rare complication. Laryngorhinootologie 1999;78:405-7.
Karas DE, Sawin RS, Sie KC. Pseudoaneursym of the external carotid artery after tonsillectomy. A rare complication. Arch Otolaryngol Head Neck Surg 1997;123:345-7.
Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg 2005;132:281-6
Simoni P, Bello A, Kent B. Pseudoaneurysm of the lingual artery secondary to tonsillectomy treated with selective embolization. International Journal of Pediatric Otorhinolaryngology 2001;59:125-128.
Opatowsky MJ, Browne JD. Endovascular treatment of hemorrhage after tonsillectomy in children. AJNR Am J Neuroradiol April 2001;22:713-716.
Mitchell RB, Pereira KD, Lazar RH, Long TE, Fournier NF. Pseudoaneurysm of the right lingual artery: an unusual cause of severe hemorrhage during tonsillectomy. Ear Nose Throat J 1997;76:575-6.
Shore-Lesserson L. Evidence based coagulation monitors: Heparin monitoring, thromboelastography, and platelet function. Seminars in Cardiothoracic and Vascular Anesthesia, Vol 9, No 1 (March), 2005:41-52.
Drews RE. Critical issues in hematology: anemia, thrombocytopenia, coagulopathy, and blood product transfusions in critically ill patients. Clin Chest Med 2003; 24: 607- 622.
Shander A. Anemia in the critically ill. Crit Care Clin 2004;20:159-178.
Shore-Lesserson L, Manspeizer HE. Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesth Analg 1999;88:312-9.
Hardy JF, de Moerloose P. The coagulopathy of massive transfusion. Vox Sanguinis 2005;89,123-127.
He´bert PC, McDonald BJ, Tinmouth A. Clinical consequences of anemia and red cell transfusion in the critically ill. Crit Care Clin 2004;20:225-235.