THE INFLUENCE OF DESMOPRESSIN ON BLOOD-LOSS DURING SPINAL-FUSION SURGERY IN NEUROMUSCULAR PATIENTS

Study Design. A double-blind study comparing the effects of desmopress in and a placebo (normal saline): on blood loss during spinal instrume ntation for neuromuscular scoliosis. Objective, To determine the effec tiveness of desmopressin acetate (DDAVP) in reducing operative blood l oss in hemostatically normal patients undergoing spinal fusion surgery for neuromuscular scoliosis. Summary of Background Data. Desmopressin acetate has been shown to improve bleeding times and to provide surgi cal hemostasis in patients with:platelet disorders. Its effect in redu cing bleeding times in normal patients has been the subject of debate in several surgical specialties. Recent observations that DDAVP seems to reduce bleeding times and blood loss in patients undergoing spinal surgery for neuromuscular scoliosis warranted a more focused analysis on its role in this surgical procedure. Methods. Patients undergoing s urgery for neuromuscular scoliosis were randomly assigned to receive D DAVP or placebo. Bleeding times and plasma clotting factors were measu red before the administration of the DDAVP or placebo and 60 minutes a fter. Operative blood loss was carefully measured. Results. Although t he administration of DDAVP decreased overall blood loss by an average of 19% compared with blood loss in the placebo group and blood loss pe r vertebra fused by an average of 15%, these results were not statisti cally significant. Conclusions. Bleeding time and blood toss seem to r espond better to DDAVP in some patients, in whom significant decreases were observed, than they do in others. The problem is in identifying those patients in whom a decrease in bleeding time will be elicited af ter administration of DDAVP. Preoperative administration of DDAVP to s uch patients should significantly decrease operative blood loss.