[Anesthesia for a patient with von Willebrand disease and asthma]

An emergency appendectomy was performed in a patient with von Willebrand disease (vWD) and asthma. vWD is a hemostatic disorder in which the patient lacks von Willebrand factor, playing a critical role in the mediation of platelet adhesion. A 12-year-old boy with vWD underwent an appendectomy under general anesthesia. The patient had not previously received any medication for the treatment of vWD. His bleeding time was over 18 minutes. Confact F injection improved it to 6 minutes. The patient was given Confact F during the perioperative period and no abnormal hemorrhage occurred. Heat-treated factor VIII concentrates can compensate for the low concentration of von Willebrand factor and they have been designed by several different companies and individual researchers with slight variations in composition among the various products. This indicates that some of these products can not be effective in compensating for vWD. In this particular case, Confact F was suitable for this patient with vWD (II A type). In addition, the patient was suffering from asthma. To avoid introducing any superfluous irritants that might induce an asthma attack, we removed the endotracheal tube under deep anesthesia and maintained the airway with a mask until the patient became conscious.