Coagulation Function in the Operating Room

Massive congenital intracranial teratoma: perioperative coagulation impairment

Massive congenital intracranial teratoma is a rare neoplasm with a poor prognosis. Surgery may be curative only if complete resection can ben obtained. Several single case reports have been published in the pediatric literature, mostly focusing on prenatal diagnosis. The authors describe six patients with congenital intracranial teratoma treated at their institution in the past decade. Perioperatively, a marked hemostatic derangement was observed in three of them undergoing surgery: the pathophysiology of this complication is discussed. The surgical indication itself represents an ethical dilemma when treating a large intracranial tumor with partial destruction and replacement of brain structures.

Influence of ketorolac tromethamine on clot elastic strength in humans as assessed by thromboelastography

STUDY OBJECTIVE

To evaluate the effect of ketorolac tromethamine on coagulation using thromboelastography (TEG).

DESIGN

TEGs were performed in each patient before and after ketorolac administration. Each patient's predrug results were used as control measurements for comparison with the postdrug results.

SETTING

Medical center surgical unit.

PATIENTS

Twenty ASA physical status I and II patients undergoing minor elective surgery; 12 healthy volunteers.

INTERVENTIONS

TEGs were performed in all subjects before and 60 minutes after the intramuscular (IM) administration of ketorolac tromethamine 60 mg. Ten surgical patients were studied in the intraoperative period, and 10 surgical patients were studied in the postoperative period. The 12 healthy volunteers did not undergo a surgical procedure.

MEASUREMENTS AND MAIN RESULTS

Specific parameters assessed from the TEGs were reaction time (R time), coagulation time (RK time), clot formation rate (angle of deflection), and maximum clot strength (maximum amplitude of deflection). Ketorolac administration did not cause statistically significant changes in these parameters in any of the three groups studied.

CONCLUSIONS

IM administration of ketorolac tromethamine 60 mg did not significantly alter the speed of formation or viscoelastic strength of clots as measured by TEG. These results provide additional support for prior clinical studies confirming the safety of ketorolac administration in the perioperative period.