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CARDIOVASCULAR ANESTHESIA

Platelet Function and Anesthetics in Cardiac Surgery: An In Vitro and Ex Vivo Study

Alessandro Parolari, MD, PhD^*, Daniela Guarnieri, BS, Francesco Alamanni, MD^*, Thomas Toscano, MD, PhD^*, Vito Tantalo, MD, Tiziano Gherli, MD, Susanna Colli, PhD^§, Fabrizio Foieni, MD^||, Vincenzo Franzè, MD^*, Monica Stanghellini, CCP^*, Gian Angelo Gianotti, MD, Paolo Biglioli, MD^*, and Elena Tremoli, PhD^§

*Department of Cardiac Surgery, University of Milan, Milano; Transfusional Center, Istituti Clinci di Perfezionamento, Milano; Department of Cardiac Surgery, University of Parma, Parma; §Institute of Pharmocological Sciences, University of Milan, Milano; and ||Clinical Pathology Laboratory, Centro Cardiologico IRCCS, Milano, Italy

Address correspondence and reprint requests to Alessandro Parolari, MD, Department of Cardiac Surgery, University of Milan, Centro Cardiologico, Fondazione I Monzino IRCCS, Via Parea, 4, 20138, Milano, Italy. Address e-mail to corallo{at}imiucca.csi.unimi.it

We studied the effects of the anesthetics commonly used in cardiac surgery on platelet function. Fentanyl, droperidol, succinylcholine, pancuronium, thiopental, and diazepam at therapeutic concentrations were tested for their in vitro effects on the expression of platelet membrane glycoproteins Ib and IIbIIIa (GpIb, GpIIb-IIIa) and of P-selectin in anticoagulated whole blood by flow cytometry. The expression of P-selectin was determined under basal conditions, after the incubation of blood with adenosine diphosphate (ADP) 10 µmol/L, and the stable prostaglandin endoperoxide analog U46619 1 µmol/L. No drug affected the expression of P-selectin in unstimulated and ADP- or U46619-stimulated platelets, with the exception of thiopental, which markedly decreased the U46619-induced expression of P-selectin. Thiopental concentration-dependently inhibited U46619-induced and ADP-induced platelet aggregation, with effects on U46619-induced aggregation at therapeutic concentrations. To assess ex vivo effects, the same platelet markers were also assessed in blood obtained from 10 patients undergoing elective coronary surgery. Compared with basal values, platelet response to U46619 was significantly reduced just after the administration of anesthetic drugs, and the effect persisted for 48 h after surgery. Our study suggests that, at therapeutic concentrations, thiopental inhibits U46619-induced platelet activation both in vitro and ex vivo. The mechanisms responsible of this effect, together with its clinical significance, require further investigation.

Implications: Thiopental inhibited prostaglandin-induced platelet activation at therapeutic concentrations both in vitro and ex vivo in cardiac surgical patients whereas adenosine diphosphate-induced activation was affected only at supratherapeutic drug concentrations. Thus, administration of sodium thiopental may contribute to the in vivo impairment of platelet function in patients undergoing elective cardiac surgery.

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