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

Background Intraoperative bleeding during rhinoplasty makes it difficult to sculpt cartilages. Residual blood from a wet field can lead to induration, fibrosis, and definition loss. Recent studies with desmopressin (1-deamino-8-D-arginine vasopressin) to reduce blood loss in a variety of operations and minimize postoperative bleeding problems suggest using that drug routinely for elective rhinoplasty and not just for patients with coagulation issues. Method Seventy-three consecutive rhinoplasty patients received desmopressin for the purpose of obtaining a dry operative field. The initial dose was 0.1 μg/kg. If the field was not as dry as desired, a second dose was given; if necessary, a third dose to a maximum of 0.3 μg/kg was given. All cases exhibited a satisfactorily dry field. There were no adverse effects. A retrospective comparison was made to 300 consecutive cases not receiving desmopressin. Results Thirty of the 73 patients received a starting dose of 0.1 μg/kg and nothing more. Fourteen received a second dose of 0.1 μg/kg because the field was not as dry as desired and 29 received a third dose of 0.1 μg/kg because the field was not as dry as desired. All 73 patients exhibited a satisfactorily dry field, in contrast to 9 percent in the group not receiving desmopressin. Conclusions This study confirms the hemostatic effectiveness of desmopressin at lower than normally used doses in rhinoplasty. It also confirms its safety. It suggests its use in other procedures. A larger, carefully controlled study is indicated. Clinical question/level of evidence Therapeutic, III.