Intrathecal anesthesia in Von Willebrand patient

gotosleep · Sep 21, 2005

I'm a nursing student, but I'm also a patient. I have Von Willebrand's disease and am scheduled for a hysterectomy next Wednesday. During my pre-op admission stuff, the RN told me that they use an intrathecal injection of Duramorph in addition to Versed for anesthesia in hysterectomies. I'm concerned about any possibility of spinal bleeding with an intrathecal and would rather be put under general anesthesia, but understand the reasoning behind a less aggressive anesthesia.
Anyone have any experience with Von Willebrand patients and the best type of anesthesia or any recommendations of places to look for answers.
I will talk with the anethesiologist on the day of the surgery, but would like to be informed before asking questions.
Sonya
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sonya,

historically anesthesia providers avoid using any kind of regional anesthesia in patients with Von Willebrand disease. I know that some providers are putting epidurals in parturients with normal bleeding times. i think however, the consensus is that the risk of bleeding out ways the benefits of regional anesthesia. general anesthesia is a safe and common anesthetic technique for hysterectomy. This is just my opinion, and you very well may find someone who thinks this is overly conservative.

anyway...good luck.

SchiwartRN · Sep 21, 2005

Thank you for your reply. What you wrote is exactly what I thought was the general consensus. My bleeding time today was 10 minutes, 35 seconds which is a bit over normal, but not crazily so. I still want to request a general anesthesia if they will allow that rather than risk the regional....again, thank you for your opinion.

Sonya

skipaway · Sep 21, 2005

Thank you for your reply. What you wrote is exactly what I thought was the general consensus. My bleeding time today was 10 minutes, 35 seconds which is a bit over normal, but not crazily so. I still want to request a general anesthesia if they will allow that rather than risk the regional....again, thank you for your opinion.
Sonya

Yes, they will "allow" you to have a general anesthetic. You can not be talked into anything that you are not comfortable with. I would not offer you a regional anesthetic with your history. There are many other methods of pain relief for your particular surgery...ie...PCA, the pain pumps that have an implanted catheter in the wound margins...I wish you luck.

Tenesma · Oct 6, 2005

there are many case reports in the literature of patients with Von Willebrand receiving neuraxial anesthesia (primarily in the OB anesthesia literature).

Most patients are responsive to DDAVP or at worst you can give them some Cryo or Factor VIII (factor 8 contains some VWF).

However in an elective case where a General Anesthetic is permissible, then avoiding a regional technique makes sense - especially if the patient does not want it.

But it does lead to one of my pet peeves where RNs tell patients how the anesthesia will be performed - when often it is very different from what we as anesthesia providers will plan to do. My favorite is when a nurse tells the patient in the induction room that they will get a General Anesthetic for a case that should be a MAC - and then I have to spend 20 minutes explaining to the patient why they aren't getting a GA and why it isn't appropriate...

apaisRN, RN, CRNA · Oct 6, 2005

But it does lead to one of my pet peeves where RNs tell patients how the anesthesia will be performed - when often it is very different from what we as anesthesia providers will plan to do. My favorite is when a nurse tells the patient in the induction room that they will get a General Anesthetic for a case that should be a MAC - and then I have to spend 20 minutes explaining to the patient why they aren't getting a GA and why it isn't appropriate...

How is that happening? Don't the nurses ask someone, or do they just guess at what the technique will be? Part of nursing is education, they shouldn't be giving patients unverified information.

Trauma Columnist · Oct 6, 2005

I am glad that you are consulting with your physician and hope that you find the above suggestions helpful. As I'm sure you understand, we can not provide medical advice. Thanks.

catcolalex · Oct 10, 2005

One of the absolute contraindications for regional anesthesia is patient refusal.

mwbeah · Oct 10, 2005

2003 A19

Von Willebrand disease and regional anesthesia in the parturient

Schmalenberger KP, 2Mandell GL, 2Golebiewski, KA, 3Brett, S H

UPMC Health Systems, Pittsburgh, PA; 2Magee-Women's Hospital, Pittsburgh, PA; 3UPMC School of Nursing, Pittsburgh, PA USA

Background: Parturients with von Willebrand disease (vWD) are often denied regional anesthesia to treat labor pain. The purpose of this study is to determine the safety of neuraxial analgesia in the parturient.

Methods: After IRB approval, a retrospective review of the medical records of 51 parturients with vWD who delivered a viable fetus at Magee-Womens Hospital over a ten year period was undertaken. Study groups were subsequently divided into parturients receiving regional anesthesia (RA group) for labor and delivery (epidural or spinal) and those who did not (control group). In addition to demographic and antepartum and postpartum laboratory values, hemorrhagic and neurologic complications were recorded. Data were analyzed using the t-test or chi-squared and p

Results: Of the 51 parturients, there were 34 in the RA group and 17 in the control group. Patients in the RA group had significantly greater mean ages (30.0 vs 25.9 yrs), a lower incidence of clinical hemorrhage (2/34 vs 7/17), a shorter mean bleeding time (7.4 vs 10.8 min) and received dDAVP less frequently during labor and delivery (5/34 vs 7/17). No significant hemorrhagic or neurologic complications were noted in either group. Spontaneous lady partsl delivery was greater in the control group (15/17 vs 18/34), and instrumented lady partsl delivery greater in the RA group (8/34 vs 0/17). There were no 5 min APGAR scores

Conclusions: Overall, our data supports the general safety of regional anesthesia for selected parturients with vWD who present during labor and delivery.

Reg Anesth Pain Med 2003;28:

FYI,

Mike