Anesthesia for a patient with von Willebrand's disease
Ogawa, H.; Kurashige, J.; Ohta, Y.; Suzuki, N.
Masui. Japanese Journal of Anesthesiology 30(5): 486-492
1981
ISSN/ISBN: 0021-4892 PMID: 6974253 Document Number: 174215
Anesthesia was given to a juvenile female patient with von Willebrand's disease. This disease differs from classic hemophilia by its usually milder manifestations, prolonged bleeding time, predominance of mucous membrane bleeding and autosomal inheritance. The major diagnostic criteria consist of the significant history of abnormal bleeding, reduced factor VIII activity and increased bleeding time. Abnormal platelet morphological findings, decreased adhesiveness, and positive plasma infusion test are supplementary evidences for the diagnosis. Excessive intraoperative and postoperative bleeding is the major problem in this disorder, so that the preventive administration of the lacking von Willebrand's factor VIII should be considered. In this patient, a dose of fresh plasma, determined by its preoperative infusion test, was given, but pronounced bleeding during and after surgery was noted. Surgical wound healing also was rather prolonged. Additionally administered carbazochrome sodium sulfonate and trans-4-aminomethyl cyclohexane carboxylic acid were effective as adjuvants for hemostasis. Choice of anesthetics [nitrous oxide, halothane oxygen] and anesthesia techniques and precautions for the patient's management of this disease were discussed.