[Rhinoplasty in a patient with Von Willebrand disease: case report.]

Patients with von Willebrand disease present abnormal bleeding after being wounded or during surgeries since it affects primary and secondary hemostasia due to changes in factor VIII. The objective of this report was to elucidate the pre-, peri-, and postoperative management of patients with this disorder.

A 42-year old white female, with 165 cm, 61 kg, ASA II, with a diagnosis of type 1 von Willebrand disease, underwent pre-anesthetic evaluation for rhinoplasty. She was cleared for surgery after hematological evaluation with a positive DDAVP IN26 test. On the day of the surgery, the patient received pre-anesthetic medication, was adequately monitored, oxygen was administered through a nasal cannula and intravenous desmopressin (0.4 microg.kg-1 in 100 mL of normal saline) was administered 30 minutes before the surgery. Induction was accomplished with intravenous sufentanil (1 microg.kg-1), propofol (4 mg.kg-1), and rocuronium (0.6 mg.kg-1). The patient was intubated and installed on mechanical ventilation with a CO2 absorber system and maintenance consisted of O2, N2O and sevoflurane. The surgery lasted 90 minutes. During the surgery the patient remained hemodynamically stable with negligible blood loss.

Infusion of cryoprecipitate or plasma, used in the prophylaxis and treatment of bleeding complications, produces peak concentrations of factor VIII after 48 hours and it is sustained for 72 hours; however, even though it has been approved by the FDA this has been used only in emergencies due to the relative risk of viral contamination. 1-Deamino-8-D-arginine vasopressin (DDAVP-desmopressin) increases the concentration of factor VIII besides eliminating exposure to blood borne pathogens and it has the possibility of being administered by the nose, subcutaneous, and intravenous.