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PEDIATRIC ANESTHESIA

Hemostatic Changes in Pediatric Neurosurgical Patients as Evaluated by Thrombelastograph^®

Susan M. Goobie, MD FRCPC^*, Sulpicio G. Soriano, MD^*, David Zurakowski, PhD, Francis X. McGowan, MD^*, and Mark A. Rockoff, MD^*

Departments of *Anesthesia and Biostatistics, Children’s Hospital and Harvard Medical School, Boston, Massachusetts

Address correspondence and reprint requests to Susan M. Goobie, MD, FRCPC, Department of Anesthesia, University of British Columbia, British Columbia’s Children’s Hospital, Children’s and Women’s Health Center of British Columbia, 4480 Oak St., Vancouver, Canada V6H 3V4. Address e-mail to sgoobie{at}cw.bc.ca

Thromboembolic events are a known complication in neurosurgical patients. There is evidence to suggest that a hypercoagulable state may develop perioperatively. Thrombelastograph^® (TEG^®) coagulation analysis is a reliable method of evaluating hypercoagulability. We evaluated coagulation by using TEG^® data in pediatric neurosurgical patients undergoing craniotomy to determine whether a hypercoagulable state develops intraoperatively or postoperatively. Thirty children undergoing craniotomy for removal of a tumor or seizure focus were studied. Blood was analyzed with TEG^® data by using native and celite techniques, at three time points for each patient: preoperatively after induction of anesthesia; intraoperatively during closure of the dura; and on the first postoperative day. Compared with preoperative indices, closing and postoperative celite TEG^® values were indicative of hypercoagulability with shortened coagulation time values (P < 0.001), prolonged angle divergence values (P < 0.001), and above-normal TEG^® coagulation indices (P 0.002). Reaction time values were shortened, and maximal amplitude of clot strength values were prolonged but did not reach statistical significance. Hypercoagulation develops early after resection of brain tissue in pediatric neurosurgical patients as assessed by using TEG^® data. Further studies are needed to determine the clinical significance of this hypercoagulable state.

IMPLICATIONS: Hypercoagulability in postoperative neurosurgical patients has been demonstrated in the adult population, but few studies have dealt with the pediatric population. We found that children undergoing craniotomy for focal resection, lobectomy, and hemispherectomy are hypercoagulable as detected by thrombelastograph^® coagulation analysis. Further studies are needed to determine whether this is clinically significant.

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