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Thromb Haemost 1992; 68(04): 436-441
DOI: 10.1055/s-0038-1646293
Original Article
Schattauer GmbH Stuttgart

The Hemodynamic and Fibrinolytic Response to Low Dose Epinephrine and Phenylephrine Infusions During Total Hip Replacement Under Epidural Anesthesia

Nigel E Sharrock
The Department of Anesthesiology, The Hospital for Special Surgery, New York, USA
,
George Go
The Department of Anesthesiology, The Hospital for Special Surgery, New York, USA
,
Robert Mineo
The Department of Anesthesiology, The Hospital for Special Surgery, New York, USA
,
Peter C Harpel
1   The Division of Hematology, Mount Sinai School of Medicine, New York, USA
› Author Affiliations
Further Information

Publication History

Received 27 January 1992

Accepted after revision 05 May 1992

Publication Date:
04 July 2018 (online)

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Summary

Lower rates of deep vein thrombosis have been noted following total hip replacement under epidural anesthesia in patients receiving exogenous epinephrine throughout surgery. To determine whether this is due to enhanced fibrinolysis or to circulatory effects of epinephrine, 30 patients scheduled for primary total hip replacement under epidural anesthesia were randomly assigned to receive intravenous infusions of either low dose epinephrine or phenylephrine intraoperatively. All patients received lumbar epidural anesthesia with induced hypotension and were monitored with radial artery and pulmonary artery catheters.

Patients receiving low dose epinephrine infusion had maintenance of heart rate and cardiac index whereas both heart rate and cardiac index declined significantly throughout surgery in patients receiving phenylephrine (p = 0.0001 and p = 0.0001, respectively). Tissue plasminogen activator (t-PA) activity increased significantly during surgery (p <0.0005) and declined below baseline postoperatively (p <0.005) in both groups. Low dose epinephrine was not associated with any additional augmentation of fibrinolytic activity perioperatively. There were no significant differences in changes in D-Dimer, t-PA antigen, α2-plasmin inhibitor-plasmin complexes or thrombin-antithrombin III complexes perioperatively between groups receiving low dose epinephrine or phenylephrine. The reduction in deep vein thrombosis rate with low dose epinephrine is more likely mediated by a circulatory mechanism than by augmentation of fibrinolysis.

 

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