A Study of Desmopressin and Blood Loss during Spinal Fusion for Neuromuscular Scoliosis

Theroux, Mary C.; Corddry, David H.; Tietz, Amy E.; Miller, Freeman; Peoples, Joseph D.; Kettrick, Robert G.

doi:10.1097/00000542-199708000-00012

Cited by 62 publications

(23 citation statements)

References 25 publications

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“…The prophylactic administration of desmopressin was found effective in reducing blood transfusions in earlier studies, but not in the most recent randomized controlled trials (RCTs). 3 Similarly, a recent RCT in liver resections did not result in any beneficial effect of desmopressin. …”

Section: 12-non Cardiac Surgerymentioning

confidence: 93%

Pharmacological approaches to reducing blood loss and transfusions in the surgical patient

Ozier

Schlumberger

2006

Can J Anesth/J Can Anesth

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Section: 12-non Cardiac Surgerymentioning

confidence: 93%

Pharmacological approaches to reducing blood loss and transfusions in the surgical patient

Ozier

Schlumberger

2006

Can J Anesth/J Can Anesth

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“…18,20 Clinical trials in neuromuscular scoliosis are limited, to date focusing on blood loss reduction. 22,23 As Rett syndrome is rare, 24 clinicians usually have exposure to small patient series.…”

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confidence: 99%

Guidelines for Management of Scoliosis in Rett Syndrome Patients Based on Expert Consensus and Clinical Evidence

Downs

Bergman²,

Carter³

et al. 2009

Spine

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Study Design. Modified Delphi technique.Objective. To develop guidelines for the clinical management of scoliosis in Rett syndrome through evidence review and consensus expert panel opinion.Summary of Background Data. Rett syndrome is a rare disorder and clinical expertise is thus with small case series. Scoliosis is a frequent association and the evidence base dealing with scoliosis management in this syndrome is limited. Parents of affected girls and women have expressed needs for more information about scoliosis and Rett syndrome.Methods. An initial draft of scoliosis guidelines was created based on literature review and open-ended questions where the literature was lacking. Perspectives of four parents of Rett syndrome patients informed this initial draft. Access to an online and a Microsoft Word formatted version of the draft were then sent to an international, multidisciplinary panel of clinicians via e-mail with input sought using a 2-stage modified Delphi process to reach consensus agreement. Items included clinical monitoring and intervention before the diagnosis of scoliosis; monitoring after the diagnosis of scoliosis; imaging; therapy and conservative management; bracing; and preoperative, surgical, and postoperative considerations.Results. The first draft contained 71 statements, 65 questions. The second draft comprised 88 items with agreement to strong agreement achieved on 85, to form the final guideline document. A comprehensive, life-span approach to the management of scoliosis in Rett syndrome is recommended that takes into account factors such as physical activity, posture, nutritional and bone health needs. Surgery should be considered when the Cobb angle is approximately 40°to 50°and must be supported by specialist management of anesthesia, pain control, seizures, and early mobilization.Conclusion. Evidence-and consensus-based guidelines were successfully created and have the potential to improve care of a complex comorbidity in a rare condition and stimulate research to improve the current limited evidence base.

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“…[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] Of all the types of surgeries, spinal fusion and cardiac operations have been the most extensively studied (Tables II and III). For patients with idiopathic scoliosis, predonation with or without the addition of erythropoietin is probably the safest and the most effective way to avoid the use of allogenic blood products.…”

mentioning

confidence: 99%

“…52 Desmopressin has been proven ineffective for idiopathic as well as neuromuscular disease induced-scoliosis. 43,44 The safety of retransfusing shed wound blood has not been well established. This practice carries a definite risk of bacterial contamination and, for scoliosis or open heart surgery, 53 cannot be recommended.…”

mentioning

confidence: 99%

Réduire les pertes sanguines et les besoins transfusionnels en chirurgie pédiatrique

Guay

Moerloose

Lasne

2006

Can J Anesth/J Can Anesth

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Purpose: To summarize the physiology and pathophysiology relevant to perioperative blood loss in children. Strategies to reduce blood losses are reviewed. Methods:The literature was reviewed using the electronic library PUBMED and the Cochrane Database of Systematic Reviews. Relevant studies published in English or French with an English abstract are included. The following keywords were used: children, blood transfusion, surgical blood loss, erythropoietin, autologous blood, red blood cell saver, normovolemic hemodilution, desmopressin, aminocaproic acid, tranexamic acid, aprotinin, cardiac surgery, liver transplantation and scoliosis surgery. Main findings:For patients with idiopathic scoliosis, predonation with or without the addition of erythropoietin is a safe and effective way to avoid the use of allogenic blood products. For open heart procedures: whole blood of less than 48 hr is helpful for children of less than two years of age undergoing complex procedures; tranexamic acid may be helpful for cyanotic heart disease and, to a lesser degree, for reoperations; while antikallikrein blood levels of aprotinin may both reduce the need for allogenic blood transfusions and improve postoperative oxygenation in infants. Conclusion:Reducing perioperative allogenic blood transfusions is possible in pediatric patients provided that prophylactic measures are adapted to age, disease and type of surgery. I N normal children perioperative blood loss leading to administration of allogenic transfusion may be encountered if: the surgical site does not allow easy access to surgical hemostasis, the surgery is performed on highly vascularized tissues that are not easily sutured or cauterized (for example bone elements such as in spinal fusion or correction of craniosynostosis) or the surgery itself induces various disturbances of hemostasis (dilution of factors and induction of fibrinolysis as in cardiac surgery with the use of extracorporeal bypass). The pathology justifying the surgical procedure may also induce various coagulation and/or hemostatic abnormalities. Children suffering from congenital cardiac or liver dis- ease may have thrombocytopenia, abnormal platelet function (congenital heart disease) and/or inadequate amounts of various coagulation factors. Objectif1 Perioperative management of children with congenital coagulation and hemostatic diseases will not be discussed in this review. Developmental aspects of hemostasisAn excellent summary of the developmental physiology of coagulation, based mainly on the extensive work of Maureen Andrew, may be found in a recent review by Kuhle et al. and is summarized in Table I.2 Since maternal coagulation factors do not cross the placental barrier, blood levels measured at birth are the result of fetal synthesis that starts around the fifth week of gestation. Fetal blood becomes clottable around 11 weeks of gestation. Except fetal fibrinogen which has an increased content of sialic acid, all coagulation and inhibitor factors are qualitatively normal at birth, and differ from...

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A Study of Desmopressin and Blood Loss during Spinal Fusion for Neuromuscular Scoliosis

Abstract: 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. Administration of DDAVP significantly increased factor VIIIC and vWF levels.

Cited by 62 publications

References 25 publications

Pharmacological approaches to reducing blood loss and transfusions in the surgical patient

Pharmacological approaches to reducing blood loss and transfusions in the surgical patient

Guidelines for Management of Scoliosis in Rett Syndrome Patients Based on Expert Consensus and Clinical Evidence

Réduire les pertes sanguines et les besoins transfusionnels en chirurgie pédiatrique

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