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Approaches and Management in Abdominoplasty Surgery with von Willebrand Disease in an Ambulatory Setting

Anaesthetists can encounter many various difficult and challenging patients throughout their careers. One such challenge can be encountering diseases of coagulation. These may even be asymptomatic, leading to unexpected increased bleeding intra and post-operatively. Careful management of these patients is important to reduce the risks of haemorrhage and even death. Specific recognition and proper planning management are essential with von Willebrand disease. Within our clinic such a case was managed, female, 42yo. This opens the possibilities for such patients to undertake elective operations, something as of now, is discouraged. Preoperative blood tests can be near normal, masking such patients risks. Good patient history may reveal epistaxis, increased bleeding times with cuts and abrasions, and in females very heavy lengthy menstrual periods. All of these mentioned do not necessarily mean von Willebrand disease is present, but high suspicion should be considered. This disease affects 1% of the general population, affecting males and females and there is limited epidemiological knowledge as to areas of prevalence. There remains the need to develop national registries and create basic screening methods and widely available treatments. Encountering such patients should not cause distress within the operative team, with advanced knowledge and preparation the anaesthesia and surgical process can be safer and smoother. Tranexamic acid (Cyclokapron, Azeptil) 3 x 1g (every 8 hours, 5-10 days) can be given for minor procedures such as dental, local skin excisions. While for larger procedures tranexamic acid (Cyclokapron, Azeptil) combined with DDAVP - Desmopressin (Minirin) is given 30 minutes before starting operations, such as hysterectomy, rhinoplasty, abdominoplasty, with rigorous control of fluid intake. Then tranexamic acid is given every 8 hours during and following surgery for 7-10 days. Consultation with a haematologist is always beneficial and eases organisation of a possible tertiary assistance intervention. Regardless of being challenging cases, procedures lasting up to 8 hours or more, these patients can be planned for elective procedures safely, leading to a broader horizon of aesthetic options.

Approaches and Management , Abdominoplasty Surgery with von Willebrand Disease , Ambulatory Setting

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