THE ROLE OF DDAVP (DESMOPRESSIN) IN ORTHOGNATHIC SURGERY

Desmopressin (1-deamino-8-D-argininevasopressin, DDAVP) is a synthetic analog of the antidiuretic hormone L-argininevasopressin. DDAVP has b een shown to increase the plasma concentration of endothelial factor V III, thus increasing coagulant activity, There is evidence from contro lled clinical trials indicating that DDAVP can reduce blood loss and t ransfusion requirements for individuals with normal coagulation profil es undergoing various surgical procedures. This study was conducted to evaluate the efficacy of the DDAVP in reduction of blood loss during orthognathic surgery. Twenty patients, 15 females and 5 males, undergo ing bimaxillary osteotomy were randomized into two groups often. Perio peratively, group I patients received 20 pg of DDAVP infused over one- half hour, Group II patients did not receive DDAVP, Hypotensive anesth esia (mean arterial pressure <60 mm Hg) was routinely employed for bot h groups, On average, the blood loss in group I patients was 144 ml le ss per patient than group II patients (p < 0.50). Only 2 of 10 patient s in group I lost in excess of 750 ml, while 6 of 10 group II patients experienced blood loss greater than 750 ml (p < 0.20). The average po stoperative hematocrit for patients in group I dropped by 6.17 of the preoperative mean hematocrit (p < 0.001). The average drop in hematocr its among the group II patients was 11.61 (p < 0.001). When collated, this hematocrit drop of 11.61 for group II and 6.17 for group I (recip ients of DDAVP) proved to be significantly different (p < 0.01). It is concluded from this study that patients receiving a standard dose of DDAVP prior to bimaxillary osteotomy would experience reduced intraope rative blood loss, providing that blood pressure is well controlled an d fluid replacement is carefully managed. No significant adverse side effects of desmopressin acetate were observed.