title: Use of desmopressin for unremitting epistaxis following septorhinoplasty and turbinectomy.
abstract: BACKGROUND
  Cauterization, nasal packing, and topical and/or injection of intranasal vasoconstrictors have been the mainstay of treatment for epistaxis following outpatient nasal surgery. In this study, the authors report the clinical outcomes in a cohort of patients with postoperative epistaxis managed with a single dose of intravenous desmopressin.
  
  
  METHODS
  A retrospective chart review of 268 consecutive nasal operations (rhinoplasty, septoplasty, and/or turbinectomy for cosmetic and/or functional purposes) was conducted. Information on demographics, perioperative blood pressure, postoperative management, and effectiveness of the measures used was assessed. The primary outcome variable was cessation of bleeding.
  
  
  RESULTS
  Nine patients were identified who experienced excessive postoperative bleeding following discharge from the surgical facility. Each patient received 0.3 μg/kg of intravenous desmopressin over 30 minutes under the supervision of the local emergency room physician with verbal instructions from the treating plastic surgeon. After administration of desmopressin, bleeding either stopped completely (eight patients) or slowed down significantly to allow discharge (one patient). No significant adverse side effects of desmopressin were observed. No patient was known to be taking medication negatively affecting coagulation perioperatively. Preoperatively, two patients were documented to have von Willebrand disease and thus received desmopressin preoperatively. Average blood pressure was 116/71 mmHg intraoperatively (range, 109 to 126/66 to 83 mmHg) and 118/74 mmHg postoperatively (range, 105 to 129/65 to 85 mmHg).
  
  
  CONCLUSIONS
  Unremitting postoperative epistaxis following outpatient nasal surgery can be successfully controlled by a protocol using intravenous desmopressin without the need for alternative maneuvers.
authors.affiliation: Cleveland, Ohio; and Dallas, Texas From the Departments of Plastic Surgery of Case Western Reserve University and University of Texas Southwestern Medical Center.
authors.forename: Carey
authors.initials: C
authors.lastname: Faber
authors.forename: Kelsey
authors.initials: K
authors.lastname: Larson
authors.forename: Bardia
authors.initials: B
authors.lastname: Amirlak
authors.forename: Bahman
authors.initials: B
authors.lastname: Guyuron
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage*; D004844:Epistaxis / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007431:Intraoperative Complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000601:surgery*; D011183:Postoperative Complications / Q000188:drug therapy*; D019106:Postoperative Hemorrhage / Q000188:drug therapy*; D012225:Rhinoplasty / Q000009:adverse effects*; D016896:Treatment Outcome; D014420:Turbinates / Q000601:surgery*; D055815:Young Adult; D014842:von Willebrand Diseases / Q000150:complications
chemical_list: D006490:Hemostatics; D003894:Deamino Arginine Vasopressin