Thromboelastography as a point-of-care guide for spinal anesthesia in an eclamptic patient: a case report
Tromboelastografia como orientação à beira-leito para raquianestesia em paciente com eclâmpsia: relato de caso
Neuraxial anesthesia is a standard of care during parturition. Since bleeding diathesis is a contraindication to neuraxial techniques, data about its safe administration in a thrombocytopenic milieu is limited and evolving. Thrombocytopenia associated with preeclampsia or eclampsia and hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome leads to significant maternal and neonatal morbidity. We present a case of uneventful spinal anesthesia for urgent cesarean section in an eclamptic patient with a precipitous drop in platelet count from 124,000 to 97,000 per cubic millimeter under thromboelastography (TEG) guidance.
1 C.G. Goodier, J.T. Lu, L. Hebbar, et al. Neuraxial Anesthesia in Parturients with Thrombocytopenia: A multisite retrospective cohort study Anesth Analg, 121 (2015), pp. 988-991
2 American College of Obstetricians and Gynecologists Thrombocytopenia in pregnancy: practice bulletin nº 166 Obstet Gynecol, 128 (2016), pp. e43-53
3 L.O. Lee, B.T. Bateman, S. Kheterpal, et al. Multicenter perioperative outcomes group investigators. Risk of epidural hematoma after neuraxial techniques in thrombocytopenic parturients: a report from the multicenter perioperative outcomes group Anesthesiology, 126 (2017), pp. 1053-1063
4 American Society of Anesthesiologists task force on obstetric anesthesia Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists task force on obstetric anesthesia Anesthesiology, 106 (2007), pp. 843-863
5 L.M. Goetzl, ACOG committee on practice bulletins-obstetrics ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists Number 36, July 2002. Obstetric analgesia and anesthesia Obstet Gynecol, 100 (2002), pp. 177-191