A STUDY OF DESMOPRESSIN AND BLOOD-LOSS DURING SPINAL-FUSION FOR NEUROMUSCULAR SCOLIOSIS - A RANDOMIZED, CONTROLLED, DOUBLE-BLINDED STUDY

Background: Studies examining the use of desmopressin acetate (DDAVP) have shown variable results In DDAVP's efficacy for reducing blood los s, Studies of adults having cardiac surgery and of children having spi nal fusion have suggested that patients with complicated medical histo ries and complex surgical procedures may benefit from use of DDAVP. Th erefore, this study was designed to examine the homeostatic effects of DDAVP in children with severe cerebral palsy undergoing spinal fusion . Methods: A randomized, double-blinded, and placebo-controlled trial of DDAVP was designed to enroll 40 patients, However, termination of t he study was advised by the Institutional Review Board after 21 patien ts were enrolled. All patients had spastic quadriplegic-type cerebral palsy and were randomly assigned to one of two groups, The DDAVP group received 0.3 mu g/kg DDAVP in 100 mi normal saline, and the placebo g roup received normal saline alone, All patients were anesthetized with nitrous oxide, oxygen, isoflurane, and fentanyl. Factor VIIIC and von Willebrand's factor (vWF) concentrations were measured in blood drawn before DDAVP Infusion and 1 h after infusion. Blood pressure was main tained at a systolic pressure of less than 100 mmHg. Use of crystalloi ds, packed erythrocytes, platelets, and fresh frozen plasma were based on criteria established by protocol Estimated blood loss was assessed by weighing sponges and measuring suctioned blood from canisters, Res ults: Estimated blood loss (intraoperative and postoperative) and amou nt of packed erythrocytes transfused were similar for the DDAVP and pl acebo groups, Concentrations of both factor VIIIC and vWF were signifi cantly greater after DDAVP infusion whets compared with concentrations after placebo infusion, Conclusions: In the children who had complex spinal fusion, there was no difference in estimated blood loss between those who received DDAVP and those who received a placebo, Administra tion of DDAVP significantly increased factor VIIIC and vWF levels.