Anesthesia in two patients with essential thrombocythemia
Okada, Y.; Hino, H.; Nagahama, H.; Kinouchi, H.; Sakamoto, M.; Aoki, T.
Masui. Japanese Journal of Anesthesiology 46(11): 1470-1473
1997
ISSN/ISBN: 0021-4892 PMID: 9404129 Document Number: 469519
Case 1. The patient was a 69-year-old man with essential thrombocythemia (ET), who underwent urgent laparotomy. On admission he was dehydrated and the platelet count was more than 160 X 104 cntdot mul-1, with hematocrit of 50%. Anesthesia was induced with ketamine i.v. and maintained with nitrous oxide and sevoflurane in oxygen. Postoperative care included the administration of gabexate mesilate (GM) which is an antiplatelet agent. Case 2. An 84-year-old woman with ET was diagnosed as gastric cancer and elective gastrectomy was scheduled. The platelet count was more than 100 X 104 cntdot mul-1. The patient was anesthetized with nitrous oxide and oxygen supplemented with fentanyl and mepivacaine via epidural catheter. Intravenous infusion of GM was performed at a rate of 1 mg cntdot kg-1 cntdot hr-1 during surgery. PF-4 and beta-TG were measured. These are platelet releasing factors. The level of PF-4 decreased to normal level during this procedure. In conclusions, it will be important to use GM during anesthesia in order to avoid the complications such as myocardial or pulmonary infarction caused by thrombocythemia.