The influence of desmopressin on blood loss during spinal fusion surgery in neuromuscular patients.
METHODS
A double-blind study comparing the effects of desmopressin and a placebo (normal saline) on blood loss during spinal instrumentation for neuromuscular scoliosis.


OBJECTIVE
To determine the effectiveness of desmopressin acetate (DDAVP) in reducing operative blood loss in hemostatically normal patients undergoing spinal fusion surgery for neuromuscular scoliosis.


BACKGROUND
Desmopressin acetate has been shown to improve bleeding times and to provide surgical hemostasis in patients with platelet disorders. Its effect in reducing bleeding times in normal patients has been the subject of debate in several surgical specialties. Recent observations that DDAVP seems to reduce bleeding times and blood loss in patients undergoing spinal surgery for neuromuscular scoliosis warranted a more focused analysis on its role in this surgical procedure.


METHODS
Patients undergoing surgery for neuromuscular scoliosis were randomly assigned to receive DDAVP or placebo. Bleeding times and plasma clotting factors were measured before the administration of the DDAVP or placebo and 60 minutes after. Operative blood loss was carefully measured.


RESULTS
Although the administration of DDAVP decreased overall blood loss by an average of 19% compared with blood loss in the placebo group and blood loss per vertebra fused by an average of 15%, these results were not statistically significant.


CONCLUSIONS
Bleeding time and blood loss seem to respond better to DDAVP in some patients, in whom significant decreases were observed, than they do in others. The problem is in identifying those patients in whom a decrease in bleeding time will be elicited after administration of DDAVP. Preoperative administration of DDAVP to such patients should significantly decrease operative blood loss.
Letts
M
M
Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
Pang
E
E
D'Astous
J
J
Jarvis
J
J
Lawton
L
L
Luke
B
B
Rhine
E
E
Menard
E
E
D000293:Adolescent; D001760:Bleeding Time; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002648:Child; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D008297:Male; D009468:Neuromuscular Diseases / Q000601:surgery*; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion
D003894:Deamino Arginine Vasopressin