Blood-Conservation Techniques in Craniofacial Surgery

Abstract

Attempts at reducing exposure to allogeneic transfusions, using blood conservation techniques such as controlled hypotension and normovolemic hemodilution, have met with mixed results and are not always practical in small infants. Recombinant human erythropoietin (RHE), a hormone that stimulates RBC production, increases the hematocrit when administered to infants. A retrospective chart review of all patients undergoing fronto-orbital advancement for craniosynostosis by the same plastic surgeon between January 2002 and December 2002 was conducted. A subgroup of patients (10/19) received RHE as a blood-conservation strategy. Transfusion requirements were lower in the RHE group (5/10) versus the control group (9/9). Total volume of blood products transfused was statistically lower in the RHE group (154 mL RHE group versus 421 mL control) (P < 0.03). RHE combined with blood-conservation techniques was associated with a decreased need for blood transfusion, thus exposing the patient to fewer risks associated with allogeneic transfusion.

Perioperative Management of Pediatric Patients with Craniosynostosis

“…Five out of the16 infants in the study group required homologous transfusion, while 7 out of 9 infants in the control group (no treatment) received homologous transfusion. In a similar retrospective study, Meara and colleagues [47] found that transfusion requirements were lower in the study group that received recombinant human erythropoietin and iron in conjunction with other blood conserving modalities (ANH, hypervolemic hemodilution, controlled hypotension) versus the control group, that was not pretreated with erythropoietin but was managed with blood conserving techniques. The investigators concluded that erythropoietin pretreatment combined with blood-conservation modalities was associated with a decreased need for blood transfusion.…”

Minimizing transfusion requirements for children undergoing craniosynostosis repair: the CHoR protocol

“…Historically, these procedures carried a high risk for significant blood loss, and the majority of infants who underwent craniosynostosis surgery required transfusions. 8,23,34 Several techniques have been described in the literature, including strip craniectomy, in which brain growth assists in the remodeling of the skull shape (passive remodeling); extensive reconstructive craniectomies including bony repositioning and fixation to immediately correct the skull contour; and more recently, endoscopic approaches followed by postoperative helmeting. For the purposes of this study, only patients treated with an open approach were included.…”

Preoperative Use of Erythropoietin as a Mean of Blood Saving in Children with Nonsyndromic Craniosynostosis

“…В исследовании J. G. Meara и соавт., выполненном на базе детской больницы (Мельбурн, Австралия), было установлено, что гемотрансфузия у детей, перенесших эндоскопическую коррекцию НеКС, потребовалась 50% пациентов, получавших эритропоэтин и препарат железа, и всем детям контрольной группы [41].…”

“…В ряде других исследований авторы пришли к ана-логичным выводам, сводящимся к тому, что предопе-рационное применение эритропоэтина с препаратами железа в сочетании с нормоволемической гемодилюци-ей у детей, перенесших хирургическую коррекцию НеКС, повышает концентрацию гемоглобина и тем самым сни-жает потребность в гемотрансфузиях вдвое [39][40][41]. Наряду с этим также отмечено снижение продолжи-тельности пребывания пациента в стационаре, хотя это и не являлось основной целью исследований [42][43][44].…”