Anaphylactic shock and hyperfibrinolysis measured with thromboelastography.

This case report presents anaphylactic shock in which hyperfibrinolysis was diagnosed with Thromboelastography (TEG). A 45 year old female patient was scheduled for vacuum-assisted wound closure. At induction, she developed an anaphylactic shock that stabilized after standard treatment. TEG analysis revealed hyperfibrinolysis. Surgery was delayed and there were no signs of spontaneous bleeding. A repeat TEG analysis performed 30 minutes later showed a completely normalized coagulation pattern. Few reports have documented the association between anaphylactic shock and hyperfibrinolysis. This case illustrates the transient and short-lived nature of the phenomenon. The mechanisms and potential consequences are discussed.

The value of pulse pressure and stroke volume variation as predictors of fluid responsiveness during open chest surgery.

SUMMARY: We investigated the ability of pulse pressure variation and stroke volume variation to predict fluid responsiveness during mechanical ventilation in patients undergoing open chest surgery by comparing their respective correlations with cardiac output changes induced by leg elevation. Serial leg elevation manoeuvres were performed before and after sternotomy in 15 patients scheduled for elective off-pump coronary bypass surgery. Under closed chest conditions, both pulse pressure variation and stroke volume variation correlated well with the induced cardiac output changes (r = 0.856, p = 0.002 and r = 0.897, p = 0.0012, respectively). These correlations were lost for both parameters following sternotomy. Our data show that pulse pressure variation and stroke volume variation are valid predictors of fluid responsiveness under closed chest conditions but that this property no longer holds when the chest is open.