Neuraxial in vwf on L&D

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bkell101

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What is the practice at your institution for Ptl pt with type 1 vwf?

What labs do u draw? What levels do u want before neuraxial? Do u give ddavp prior to any neuraxial despite the levels?

If no time to give ddavp prior to urgent section, would u attempt neuraxial on pt with "acceptable" factor 8 and vwf:rco levels? What if she was a known difficult airway?


This came up on our labor service recently.

Thanks!!

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Too many unknowns... she goes to sleep

how about planned section in vwf patient with factor 8 and vwf:rCo levels over 100 the day before. Do you omit ddavp? Do you still treat with ddavp prior to neuraxial? What do your surgeons like?
 
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Difficult airway and vwd for c/s? That might warrant my first awake FOI in about 5 years
 
There is simply no sufficient data on the subject of neuraxial anesthesia in patients with VW and we don't really know what factor level or what treatment would make neuraxial safe.
If something goes wrong you will be crucified.
If the patient has a terrible airway then do an awake intubation.
 
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