Acute Pulmonary Dysfunction Immediately After Cesarean Delivery Under General Anesthesia

Abstract

A woman with known von Willebrand (vW) disease type 2b presented with vaginal bleeding at 38 and 2/7 weeks of gestation for repeat cesarean section. Prior to surgery she received exogenous, structurally normal vW factor in the form of Humate-P, which contains both factor 8 and vW factor. She was unintentionally overloaded with fluid prior to the induction of general anesthesia and suffered acute pulmonary dysfunction immediately after delivery, perhaps due to heart failure caused by fluid overload and light anesthesia. Incipient mainstem intubation was ruled out since it is often misdiagnosed as “bronchospasm.” She was treated with diuretics and by deepening the anesthesia and she rapidly recovered. vW disease types 1 and 3 involve an insufficient quantity of structurally normal vW factor, whereas type 2 disease involves structurally abnormal vW factor. DDAVP, which releases stored vW factor from vascular endothelium, should probably not be used in vW disease type 2.