Anesthesia for surgery related to craniosynostosis: a review. Part 2

Abstract

The management of children with craniosynostosis is multidisciplinary and has evolved significantly over the past five decades. The treatment is primarily surgical. The anesthetic challenges continue to be the management of massive blood transfusion and prolonged anesthesia in small children, often further complicated by syndrome-specific issues. This two-part review aims to provide an overview of the anesthetic considerations for these children. The first part described the syndromes associated with craniosynostosis, the provision of services in the UK, surgical techniques, preoperative issues and induction and maintenance of anesthesia. This second part will explore hemorrhage control, the use of blood products, metabolic disturbance and postoperative issues.

Factors Influencing Blood Loss and Postoperative Morbidity in Children Undergoing Craniosynostosis Surgery: A Retrospective Study

“…Additionally, some metabolic syndromes may be encountered after craniosynostosis surgery [23]. Some studies recommend a minimum of 24 h of follow-up of patients postoperatively [8,24]. We did not encounter serious complications in the postoperative period.…”

“…Anesthetic management during corrective surgery of craniosynostosis is very challenging. Serious problems can be encountered, most of which are related to blood loss during the operation and hemodynamic instability, where blood loss generally exceeds 40 ml/kg [8,12]. van Uitert et al [5] found an average of 55.2 ± 39.8 ml/kg blood loss in their study of 44 craniosynostosis patients.…”

“…Patients can have severe blood loss in the early postoperative periods. Blood loss into the drains was closely monitored and blood gas measurements were performed to help guide therapy [8]. In our study, patients needed more than 14 ml/kg of RBC transfusion in the early postoperative period.…”

“…Transfusion triggers may vary in different centers. Generally, values of 21-24% are accepted as the transfusion trigger [8]; however, there are centers performing transfusions with higher levels of Hct [12,20]. We used an Hct level of 25% as the transfusion trigger in our study.…”

“…Excessive intraoperative transfusion can cause increased morbidity and various complications [7]. Values that are used for the blood product transfusion decision include hematocrit (Hct) level, central venous pressure (CVP), heart rate (HR), and mean arterial pressure (MAP) [8]. Using only one of these values can be deceptive.…”