Anestesia para septoplastia e turbinectomia em paciente portador de doença de von Willebrand: relato de caso

Abstract

Although von Willebrands disease is the most common hereditary hemorrhagic disorder, there are few reports in Brazilian literature relating this disease to anesthesia. This report aimed at describing a case of general anesthesia for septoplasty and turbinectomy in a von Willebrands disease type I patient, prophylactically treated with desmopressin (1-deamine-8-D- arginine vasopressin, DDAVP) in the pre and postoperative period. A female patient, 19 years old, 58 kg, with hypothyroidism controlled with L-tiroxine (75 mg) had her von Willebrands disease manifested three years before after a wisdom tooth extraction with persistent bleeding in the postoperative period. To prevent new per and postoperative hemorrhagic episodes, patient was prophylactically treated with desmopressin (0.3 microg.kg-1). Anesthesia was induced with midazolam (2.5 mg), fentanyl (150 microg), droperidol (2.5 mg), lidocaine (60 mg), atracurium (30 mg) and metoprolol (4 mg), followed by tracheal intubation and ventilation under intermittent positive pressure. Anesthesia was maintained with 2% sevoflurane in a mixture of 50% oxygen and nitrous oxide. This technique provided a good heart rate and blood pressure control during surgery. Patient remained with a nasal tampon for 24 hours and no bleeding was observed at its removal. Patient was discharged the day after surgery uneventfully. There were no immediate or late postoperative bleeding. The prophylactic treatment with DDAVP associated to the anesthetic technique used in this case was effective in controlling peri and postoperative bleeding.