Desmopressin as a hemostatic agent to provide a dry intraoperative field in rhinoplasty

Overview

Bleeding during rhinoplasty obscures the cartilage the surgeon is trying to shape, and blood left in the tissues can lead to hardening, scarring and loss of definition. Desmopressin has been used to reduce blood loss in other operations. The authors gave it routinely to elective rhinoplasty patients, not only those with clotting problems, and compared the result with their previous practice.

Sections of note

• 73 consecutive rhinoplasty patients received desmopressin, starting at 0.1 micrograms per kilogram.
• Further doses of 0.1 micrograms per kilogram were given if the field was not dry enough, to a maximum of 0.3.
• 30 patients needed only the starting dose, 14 needed a second dose and 29 needed a third.
• All 73 patients achieved a satisfactorily dry field.
• In the retrospective comparison group of 300 consecutive patients who did not receive the drug, 9 percent had a dry field.
• No adverse effects were reported. Level of evidence 3, therapeutic.

What it means for a patient

• Less bleeding during the operation gives the surgeon a clearer view of the cartilage being shaped.
• The drug worked at doses below those normally used elsewhere, and no side effects were seen in this group.
• The comparison group was drawn from earlier cases rather than assigned at random, so surgical experience and technique may have changed between the groups.
• The measured outcome is how dry the field looked to the surgeon, not blood loss in millilitres, bruising, swelling or the final appearance of the nose.

Why this paper matters

A dry field is the practical precondition for precise cartilage work, and surgeons currently rely on positioning, local anaesthetic with adrenaline and blood pressure control. This series suggests a pharmacological addition at low dose. The authors state a larger, carefully controlled study is needed, and safety in a wider population is not established by 73 cases.

Terms

• Hemostatic agent: a drug that reduces bleeding.
• Desmopressin: a synthetic hormone that increases clotting factor activity, also called DDAVP.
• Intraoperative field: the area the surgeon is working in during the operation.
• Induration: abnormal hardening of tissue.
• Fibrosis: the formation of scar tissue.
• Level of evidence 3: a study with a comparison group that was not randomly assigned.