Perioperative Desmopressin for Patients Undergoing Otolaryngologic Procedures: A Systematic Review.

Abstract

OBJECTIVE:

Desmopressin (DDAVP) is a hemostatic agent used to manage bleeding in patients with hemostatic disorders, and there is a lack of published data to guide its use during otolaryngology procedures. The objective of this study was to conduct an evidence-based systematic review of the reported uses, efficacy, and adverse effects of DDAVP in the otolaryngology surgical setting.

DATA SOURCES:

PubMed, MEDLINE, and EmBase were searched for articles on the use of DDAVP in otolaryngology.

REVIEW METHODS:

The Methodological Index for Non-Randomized Studies criteria and Cochrane bias tool were used to assess study quality. Patient demographics, DDAVP dosing and route, and outcomes such as bleeding and adverse events were collected. A summary of evidence table was created specifying levels of evidence, benefits, and harm.

RESULTS:

Nineteen studies encompassing 440 patients were included. Sixteen studies discussed DDAVP for prophylaxis, and 3 discussed postoperative use. DDAVP effectively prevented bleeding in high-risk patients and successfully facilitated a dry surgical field when necessary. DDAVP had a 100% success rate when used symptomatically. Five studies described adverse effects, including hyponatremia (12.3%), nausea (2.0%), emesis (0.9%), and seizure (0.2%). The aggregate level of evidence for its use was Level B for adenotonsillectomy, septoplasty, and turbinate procedures and Level C for rhinoplasty.

CONCLUSION:

Current literature supports the use of DDAVP in otolaryngology surgical procedures as both a perioperative prophylactic agent and a postoperative symptomatic intervention for bleeding. Both modalities are effective with minimal adverse events. Further well-designed randomized trials are necessary to conclusively formulate guidelines for DDAVP use in otolaryngology.

• Authors: Gregory L Barinsky, David Buziashvili, Peter F Svider, Michael A Carron, Adam J Folbe, Wayne D Hsueh, Jean Anderson Eloy, Andrew P Johnson
• Journal: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (Otolaryngol Head Neck Surg) Vol. 161 Issue 1 Pg. 36-45 (07 2019) ISSN: 1097-6817 [Electronic] England
• PMID: 30857487 (Publication Type: Journal Article, Systematic Review)

Chemical References

• Hemostatics
• Deamino Arginine Vasopressin

Topics

• Blood Loss, Surgical (prevention & control)
• Deamino Arginine Vasopressin (therapeutic use)
• Hemostatics (therapeutic use)
• Humans
• Otorhinolaryngologic Diseases (surgery)