Abstract
Epidural anesthesia, combined with general anesthesia, was performed in a patient with type 1 von Willebrand disease (VWD). VWD is a common inherited bleeding disorder, and an anesthetic concern in patients with VWD is susceptibility to postoperative bleeding and epidural or spinal hematoma associated with neuraxial block. After confirming the patient’s responsiveness to 1-desamino-8-D-arginine vasopressin (DDAVP) and obtaining informed consent, epidural anesthesia was performed to avoid the use of analgesics that inhibit platelet function. The patient’s postoperative course was uneventful. Epidural anesthesia could be one of the choices of treatment for postoperative pain in those patients with type 1 VWD for whom the conditions discussed are fulfilled, to ensure safe usage of this technique.
Similar content being viewed by others
References
Nichols WL, Hultin MB, James AH, Manco-Johnson MJ, Montgomery RR, Ortel TL, et al. von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA). Haemophilia. 2008;14:171–232.
Castaman G, Federici AB, Rodeghiero F, Mannucci PM. Von Willebrand’s disease in the year 2003: towards the complete identification of gene defects for correct diagnosis and treatment (Review). Haematologica. 2003;88:94–108.
Cohen S, Daitch JS, Amar D, Goldiner PL. Epidural analgesia for labor and delivery in a patient with von Willebrand’s disease. Reg Anesth. 1989;14:95–97.
Milaskiewicz RM, Holdcroft A, Letsky E. Epidural anaesthesia and von Willebrand’s disease. Anaesthesia. 1990;45:462–464.
Mannucci PM, Ruggeri ZM, Pareti FI, Capitanio A. 1-Deamino-8-d-arginine vasopressin: a new pharmacological approach to the management of haemophilia and von Willebrands’ diseases. Lancet. 1977;I:869–872.
de la Fuente B, Kasper CK, Rickles FR, Hoyer LW. Response of patients with mild and moderate hemophilia A and von Willebrand’s disease to treatment with desmopressin. Ann Intern Med. 1985;103:6–14.
Lethagen S, Harris AS, Sjörin E, Nilsson IM. Intranasal and intravenous administration of desmopressin: effect on F VIII/vWF, pharmacokinetics and reproducibility. Thromb Haemost. 1987; 58:1033–1036.
Revel-Vilk S, Schmugge M, Carcao MD, Blanchette P, Rand ML, Blanchette VS. Desmopressin (DDAVP) responsiveness in children with von Willebrand disease. J Pediatr Hematol Oncol. 2003;25:874–879.
Mannucci PM, Canciani MT, Rota L, Donovan BS. Response of factor VIII/von Willebrand factor to DDAVP in healthy subjects and patients with haemophilia A and von Willebrand’s disease. Br J Haematol. 1981;47:283–293.
Mannucci PM, Bettega D, Cattaneo M. Patterns of development of tachyphylaxis in patients with haemophilia and von Willebrand disease after repeated doses of desmopressin (DDAVP). Br J Haematol. 1992;82:87–93.
Gill JC, Endres-Brooks J, Bauer PJ, Marks WJ Jr, Montgomery RR. The effect of ABO blood group on the diagnosis of von Willebrand disease. Blood. 1987;69:1691–1695.
Author information
Authors and Affiliations
About this article
Cite this article
Hara, K., Kishi, N. & Sata, T. Considerations for epidural anesthesia in a patient with type 1 von Willebrand disease. J Anesth 23, 597–600 (2009). https://doi.org/10.1007/s00540-009-0782-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-009-0782-z