Perioperative assessment of coagulation in paediatric neurosurgical patients using thromboelastography

Background anal objective Primary brain tumours may be associated with coagulation disorders, which can pose intraoperative and postoperative management difficulties. Thromboelastography is a useful technique for evaluating coagulability. In this study, we evaluated the perioperative coagulation profile using both standard laboratory work and thromboelastography in paediatric patients undergoing craniotomy for primary brain tumours. Methods Forty paediatric patients were enrolled in the study. All patients received standard anaesthesia. Blood was analysed for both standard laboratory analysis and thromboelastography at three points for each patient: preoperatively, intraoperatively and postoperatively. Postoperative patients were divided into two groups according to the occurrence or nonoccurrence of postoperative haematomas: nonhaematoma group and haematoma group. The standard blood analysis and thromboelastography values for both groups were compared. Results Perioperative standard blood analysis was within normal limits for all patients, with no significant difference between both groups. In the nonhaematoma group, thromboelastography values were indicative of a hypercoagulable state that started intraoperatively and continued into the first postoperative day. In the haematoma group, thromboelastography values were indicative of a hypocoagulable state that was evident in the preoperative thromboelastography values and continued into the intraoperative as well as the postoperative period. Conclusion Thromboelastography may be useful in the perioperative assessment and monitoring of coagulation in paediatric neurosurgical patients and helps in identifying patients at increased risk of bleeding or thromboembolic events. Eur J Anaesthesiol 26:293-297 (c) 2009 European Society of Anaesthesiology.