Platelet function as affected by total intravenous and inhalational anesthesia

Background: Few studies have attempted to demonstrate a benefit of a total intraveneous anesthesia (TIVA) as the sole technique to optimize and reduce bleeding. Also few reports have linked the use of propofol to platelet dysfunction, and while Thromboelastography (TEG®) has been used previously, its complement platelet mapping (PM™) has not. The aim of the study was to exclude different causes for blood loss during surgery, including drug effects on platelet function. Methods: After IRB approval, we studied 23 patients scheduled to undergo endoscopic sinus surgery. Using a double-blind experimental method, we randomly assigned patients to receive either TIVA with propofol/remifentanil (PR) or inhalational anesthesia with sevoflurane/remifentanil (SR). Results: Estimated blood loss (PR 152.9 ± 161.3 cc/SR 355.9 ± 393.4 cc) showed no significant group difference. Platelet function was within the normal range for both groups, though several preoperative TEG® parameters were statistically different between the two groups (PR values were greater than SR values for MA Activator, ADP MA, AA MA and ADP Aggregation; SR value was greater than PR value for ADP Inhibition). Several TEG® PM™ parameters had statistically significant differences pre- and postoperatively in the SR group (Postoperative were greater for ADP MA and ADP Aggregation; Preoperative value was greater for ADP Inhibition). Individual patient abnormalities were noted. Conclusion: The results do not indicate any significant difference between propofol and sevoflurane as concerns blood loss and platelet inhibition.