Surgery and anesthesia cause a significant emotional stress in both parents and children. Since the consequences of this stress develop immediately after surgery and can last even when the hospital treatment is over, the role of the anesthesiologist is to ensure psychological as well as physiological well-being of the patient. In order to reduce emotional stress induced by anesthesia and operation, the anesthesiologist has to understand certain developmental phases that children go through and to identify situations which a child could potentially see as a danger or a threat. This can usually be achieved by careful preoperative assessment and by administering preoperative sedation. During the preoperative visit to the patient, the anesthesiologist can evaluate the levels of anxiety of both parents and children as well as assess the child's medical condition.

Ultrasound guided lower limb peripheral nerve blocks are an efficient technique of regional anesthesia in children. They reduce the amount of general anesthetics and opioid analgesics needed intraoperatively as well as the level of postoperative pain and consumption of analgesics postoperatively.

Extensive blood loss is common in pediatric scoliosis correction surgery, transfusion being unavoidable in the majority of cases. In our patient, tranexamic acid proved safe and effective in reducing perioperative blood loss and transfusion requirement.

Introduction?Extensive blood loss is common in pediatric craniosynostosis reconstruction surgery and so are transfusion-related morbidity and mortality. Tranexamic acid is an antifibrinolytic agent and is increasingly being used in children to reduce perioperative blood loss in various settings, including during craniosynostosis surgery. Case Report?An 8-month-old, 9-kg male infant was admitted to our hospital for craniosynostosis repair. The operation was performed under a balanced general anesthesia. Two central lines and one peripheral line were cannulated in case of a need of massive transfusion. Invasive monitoring was used, as well as prevention of hypothermia. As massive blood loss was expected, before beginning the surgery bolus of tranexamic acid as well as packed red blood cells was administered. During the operation, tranexamic acid was given continuously in an intravenous infusion. The child was hemodynamically stable throughout the operation. After the completion of surgery, which lasted for 5 hours, the patient was extubated in the operating room. Postoperatively, the patient was admitted to the intensive care unit, where he stayed for 24 hours. Hemoglobin values were stable, and there was no need for additional blood replacement. Conclusion?Extensive blood loss is common in pediatric craniosynostosis reconstruction surgery, transfusion being unavoidable in the majority of cases. In our patient, tranexamic acid proved effective in reducing perioperative blood loss and transfusion requirement.