[Treatment with desmopressin before epidural anesthesia in a patient with type I von Willebrand disease].
A 33-year-old primipara with von Willebrand disease type I was admitted in labor at 37 weeks, requesting epidural analgesia. The consultant hematologist advised treating with desmopressin acetate (DDAVP) before inserting an epidural catheter. Desmopressin at a dose of 0.3 microgram/Kg was administered intravenously and the catheter was inserted to L3-L4 to infuse 0.1% bupivacaine with 2 micrograms/mL of fentanyl at a rate of 12 mL/h. Four hours later the patient was brought to the operating room for forceps delivery of a healthy boy. One hour later, she had recovered normal motor tone followed by normal sensitivity in the lower extremities. The catheter was then withdrawn with no signs of bleeding. A woman with von Willebrand's disease can receive an epidural block for analgesia during childbirth. The decision to perform the block should be individualized, based on coagulation tests. DDAVP may play a role in improving hemostasis.
Pérez-Barrero
P
P
Servicio de Anestesia, Reanimación y Terapia del Dolor Hospital Universitario Miguel Servet Paseo Isabel La Católica, 1-3 50009 Zaragoza. drbarrero@able.es
Gil
L
L
Martínez
C
C
Bueno
A B
AB
Casado
A I
AI
Oro
J
J
D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy*; D014842:von Willebrand Diseases / Q000188:drug therapy*
D006490:Hemostatics; D003894:Deamino Arginine Vasopressin