Anaesthesia in craniosynostosis
Craniosynostosis is a congenital disorder requiring extensive reconstructive surgery that entails a high probability of severe bleeding, massive transfusion and difficult airway management. Considering that the anaesthetic management for this procedure has special requirements and priority targets, presenting the experience of the anaesthesiology department working under the programme for surgery of craniofacial abnormalities is of the greatest importance.
Objective: Describe the behaviour of anaesthetic variables during the perioperative period inpatients taken to craniosynostosis correction at Hospital Infantil Universitario de San José.
Methods: Retrospective observational cohort study in patients taken to surgery between January 1st 2008 and January 31st 2012. Data were collected from electronic clinical records and anaesthesia records.
Results: The most relevant data were haemorrhage and transfusion. Blood loss was 35.6 cc/kg (SD = 17.4), considered as severe haemorrhage. Patients receiving tranexamic acid did not show lower intra-operative levels of blood loss or packed red blood cell (PRBC) transfusions, shorter mechanical ventilation or ICU (intensive care unit) length of stay. We observed a smaller number of PRBC transfusions in patients in the ICU who received desmopressin.
Conclusions: The high rate of consumption of nutritional supplements in patients about to undergo surgery, possible drug interactions and adverse effects of perioperative consumption of some herbs, should be a warning to the anesthesiologist who performed the pre-anesthetic consultation; is necessary to include this in the interview and take decisions about it. We recommend to request always packing of the products
2. Soriano S, Eldredge E, Rockoff M. Pediatric neuroanesthesia. Neuroimag Clin N Am. 2007;17:259-67.
3. Goyal K, Chaturvedi A. Factors affecting the outcome of patients undergoing corrective surgery for craniosynostosis: A retrospective analysis of 95 cases. Neurol India. 2011;59:823-8.
4. Goobie S, Meier P, Pereira L. Efficacy of tranexamic acid in pediatric craniosynostosis surgery. Anesthesiology. 2011;114:1-10.
5. Dadure C, Sauter M. Intraoperative tranexamic acid reduces blood transfusion in children undergoing craniosynostosis surgery. Anesthesiology. 2011;114:856-61.
6. Neilipovitz DT, Murto K, Hall L, Barrowman NJ, Splinter WM. A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg. 2001;93:82-7.
7. Meneghini L, Zadra N, Aneloni V, Metrangolo S, Faggin R, Giusti F. Erythropoietin therapy and acute preoperative normovolaemic haemodilution in infants undergoing craniosynostosis surgery. Paediatr Anaesth. 2003;13: 392-6.
8. Fearon J, Weinthal J. The use of recombinant erythropoietin in the reduction of blood transfusion rates in craniosynostosis repair in infants and children. Plast Reconstr Surg. 2002;109:2190-6.
9. Holcomb J. Tranexamic acid in elective craniosynostosis surgery. Anesthesiology. 2011;114:737-8.
10. Guzzetta NA, Miller BE. Principles of hemostasis in children: Models and maduration [Review article]. Paediatr Anaesth. 2011;21:3-9.
11. Lavoie J. Blood transfusion risks and alternative strategies in pediatric patients. Paediatr Anaesth. 2011;21:14-24.
12. Verma S, Eisses M, Richards M. Blood conservation strategies in pediatric anesthesia. Anesthesiology Clin. 2009;27: 337-51.
13. Dahmani S, Orliaguet G, Meyer P. Perioperative blood salvage during surgical correction of craniosynostosis in infants. Br J Anaesth. 2000;85:550-5.
14. Thosrten H, Dietmar F, Corinna V. Fibinogen in craneosynostosis surgery. Anesth Analg. 2008;106:725-31.
15. Stricker P, Shaw T. Blood loss, replacement, and associated morbidity in infants and children undergoing craniofacial surgery. Paediatr Anaesth. 2010;20:150-9.
16. Pietrini D, Ciano F, Forte E. Sevoflurane-remifentanil vs isoflurano-remifentanil for the surgical correction of craniosynostosis in infants. Paediatr Anaesth. 2005;15: 653-62.
17. Choi A, Ahmad N, de Beer D. Metabolic changes during major craniofacial surgery. Paediatr Anaesth. 2010;20:851-5.
18. Kerner T, Machotta A, Kerner S, Haberl H, Riess H, Hildebrandt B. A clinical pilot study of fresh frozen plasma versus human albumin in paediatric craneofacial repair. J Int Med Res. 2008;36:171-7.
19. De Beer D, Bingham R. The child with facial abnormalities. Curr Opin Anaesthesiol. 2011;24:282-8.
20. Barnett S, Moloney C, Bingham R. Perioperative complications in children with Apert syndrome: A review of 509 anesthetics. Paediatr Anaesth. 2011;21:72-7.
21. Faberowski L, Black S, Mickle P. Incidence of venous air embolism during craniectomy for craneosynostosis repair. Anesthesiology. 2000;92:20-3.
22. Harris MM, Yemen TA, Davidson A, Strafford MA, Rowe RW, Sanders SP, et al. Venous embolism during craniectomy in supine infants. Anesthesiology. 1987;67:816-9.
23. Albin M, Souders J. Venous air embolism. En: Atlee J, editor. Complications in Anesthesia. 2nd ed. Philadelphia: Saunders; 2007. p. 704-7.
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