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Use of Desmopressin (DDAVP) for Treatment of Unremitting Epistaxis Following Septorhinoplasty and Turbinectomy
Carey Faber, A.B., Kelsey Larson, BS, Bardia Amirlak, MD, and Bahman Guyuron, MD
Department of Plastic and Reconstructive Surgery, University Hospitals Case Medical Center, Case Wes
2010-03-31
Presenter: Carey Faber (3rd year medical student)
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: Aesthetics
Background: Cauterization, nasal packing, topical and/or injection of intranasal vasoconstrictors have been the mainstay of treatment for epistaxis following outpatient nasal surgery. In this study, we report the clinical outcomes in a cohort of patients with post-operative epistaxis managed with a single dose of intravenous DDAVP.
Methods: Retrospective chart review was conducted of 268 nasal surgeries (rhinoplasty, septoplasty and/or turbinectomy for cosmetic and/or functional purposes) performed in the 45 month study period. Nine patients were identified who experienced excessive postoperative bleeding following discharge from the surgical facility. Each patient received 0.3 mcg/kg of intravenous DDAVP over 30 minutes under the supervision of the local emergency room physician with verbal instructions from the treating plastic surgeon. Information on postoperative management and effectiveness of the measures used were assessed. The primary outcome variable was cessation of bleeding.
Results: Nine patients presented for treatment on average at postoperative day 2.75 (range 0-10 days). After receiving DDAVP, bleeding either significantly slowed down allowing their discharge or completely stopped. No additional measures were required, and no significant adverse side effects of DDAVP were observed. No patient was known to be taking medication negatively affecting coagulation perioperatively. Prior to surgery, 2 patients were documented to have Von Willebrand Disease and received DDAVP preoperatively as well. Average blood pressure was 116/71 mmHg intraoperatively (range 109-126/66-83 mmHg) and 118/74 mmHg postoperatively (range 105-129/65-85 mmHg).
Conclusion: Unremitting post-operative epistaxis following outpatient nasal surgery can be successfully controlled by a protocol using intravenous DDAVP without the need for alternative maneuvers.
