Con: Desmopressin is not of value in the treatment of post-cardiopulmonary bypass bleeding

Desmopressin Has No Beneficial Effect on Excessive Postoperative Bleeding or Blood Product Requirements Associated with Cardiopulmonary Bypass

“…Several randomized double-blind trials (5,(11)(12)(13) have suggested that despite the initially encouraging results obtained by Salzman et al in patients at a high risk of bleeding (6), desmopressin should probably not be used routinely as a prophylactic agent (14,15). In patients with excessive chest tube output, by contrast, Czer et al (8) reported in a non-randomized study, that desmopressin reduced blood product requirements by half, and platelet infusions fell threefold.…”

Blood Conservation in Pediatric Cardiac Surgery

“…Desmopressin (DDAVP), a trigger for factor VII and von Willebrand factor release, has never been demonstrated to be effective in blood conservation post PCS. 62 In addition to these pharmacologic therapies to control bleeding post PCS, recombinant activated factor VII (rFVIIa) has been used as rescue therapy in severe uncontrollable hemorrhage. 63 Among the various pharmacological agents, fibrin sealant has a special role in complex repair to achieve surgical hemostasis and reduce bleeding.…”

Implications of sleep deprivation for children in the pediatric intensive care unit*

“…One study on rat pups demonstrated anatomical, biochemical, and behavioral abnormalities associated with chronic sleep deprivation, in addition to decreased REM latency and abnormal REM phases, including REM rebound (16). During REM rebound, critically ill adults are most at risk for cardiac arrhythmias and myocardial infarction (14). During REM rebound, critically ill adults are most at risk for cardiac arrhythmias and myocardial infarction (14).…”

“…One such agent is the serine proteinase inhibitor aprotonin (Trasylol), but the clinical indications and criteria for use are highly variable and even its routine use is controversial (8 -10). A third agent is desmopressin acetate (DDAVP or Desmopressin), which can increase factor VIIIC and von Willebrand's factor concentrations but has not been widely accepted as a therapeutic agent for homeostasis in postoperative pediatric cardiac patients (14). A third agent is desmopressin acetate (DDAVP or Desmopressin), which can increase factor VIIIC and von Willebrand's factor concentrations but has not been widely accepted as a therapeutic agent for homeostasis in postoperative pediatric cardiac patients (14).…”