Blood Loss During Repair of Craniosynostosis

Meyer, Philippe; Rénier, Dominique; Arnaud, Éric; Jarreau, Marie‐Madeleine; Charron, Brigitte; Buy, Eric; Buisson, Corinne; Barrier, G.

doi:10.1093/bja/71.6.854

Cited by 125 publications

(76 citation statements)

References 1 publication

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“…However, we consider that it is undesirable to expose patients to a procedure, the MSC, which still has attendant risks, 25,27 is less effective at correcting the scaphocephalic deformity, and has a markedly higher reoperation rate, with the risks that that entails. The significantly higher rate of raised ICP experienced by these patients postoperatively is a further cause of concern.…”

Section: Discussionmentioning

confidence: 99%

The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery

Thomas

Johnson

Byren

et al. 2015

PED

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OBJECT Raised intracranial pressure (ICP) is recognized to occur in patients with nonsyndromic isolated sagittal craniosynostosis (SC) prior to surgery. However, the incidence of raised ICP following primary surgery is rarely reported and there appears to be a widely held assumption that corrective surgery for SC prevents the later development of intracranial hypertension. This study reports the incidence of postoperative raised ICP in a large cohort of patients with SC treated by 1 of 2 surgical procedures in a single craniofacial unit. METHODS A retrospective review was performed of all patients with SC who underwent either a modified strip craniectomy (MSC) or calvarial remodeling (CR) procedure under the care of the Oxford Craniofacial Unit between 1995 and 2010 and who were followed up for more than 2 years. The influence of patient age at surgery, year of surgery, sex, procedure type, and the presence of raised ICP preoperatively were analyzed. RESULTS Two hundred seventeen children had primary surgery for SC and were followed up for a mean of 86 months. The overall rate of raised ICP following surgery was 6.9%, occurring at a mean of 51 months after the primary surgical procedure. Raised ICP was significantly more common in those patients treated by MSC (13 of 89 patients, 14.6%) than CR (2 of 128 patients, 1.6%). Also, raised ICP was more common in patients under 1 year of age, the majority of whom were treated by MCS. No other factor was found to have a significant effect. CONCLUSIONS Postoperative raised ICP was found in more than 1 in 20 children treated for nonsyndromic SC in this series. It was significantly influenced by the primary surgical procedure and age at primary surgery. Careful long-term follow-up is essential if children who develop raised ICP following surgery are not to be overlooked.

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Section: Discussionmentioning

confidence: 99%

The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery

Thomas

Johnson

Byren

et al. 2015

PED

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“…23,24 For repair of craniosynostosis, the type of skull deformation and surgical procedure determine the extent of intraoperative bleeding. 25 For orthognatic surgery, double-jaw procedures result in more blood loss than single-jaw procedures, boys have a higher average blood loss than girls, but average blood loss is not significantly affected by patients' age. 26 For pediatric open heart surgery, risk factors clearly associated with increased blood loss include: age less than one month, body weight under 8 kg, complexity of the procedure (arterial switches for transposition of the great vessels, Fontan procedures, Glenn shunts and truncus arteriosus repairs), duration of cardiopulmonary bypass, resternotomy, and low platelet count during cardiopulmonary bypass.…”

mentioning

confidence: 99%

Réduire les pertes sanguines et les besoins transfusionnels en chirurgie pédiatrique

Guay

Moerloose

Lasne

2006

Can J Anesth/J Can Anesth

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Purpose: To summarize the physiology and pathophysiology relevant to perioperative blood loss in children. Strategies to reduce blood losses are reviewed. Methods:The literature was reviewed using the electronic library PUBMED and the Cochrane Database of Systematic Reviews. Relevant studies published in English or French with an English abstract are included. The following keywords were used: children, blood transfusion, surgical blood loss, erythropoietin, autologous blood, red blood cell saver, normovolemic hemodilution, desmopressin, aminocaproic acid, tranexamic acid, aprotinin, cardiac surgery, liver transplantation and scoliosis surgery. Main findings:For patients with idiopathic scoliosis, predonation with or without the addition of erythropoietin is a safe and effective way to avoid the use of allogenic blood products. For open heart procedures: whole blood of less than 48 hr is helpful for children of less than two years of age undergoing complex procedures; tranexamic acid may be helpful for cyanotic heart disease and, to a lesser degree, for reoperations; while antikallikrein blood levels of aprotinin may both reduce the need for allogenic blood transfusions and improve postoperative oxygenation in infants. Conclusion:Reducing perioperative allogenic blood transfusions is possible in pediatric patients provided that prophylactic measures are adapted to age, disease and type of surgery. I N normal children perioperative blood loss leading to administration of allogenic transfusion may be encountered if: the surgical site does not allow easy access to surgical hemostasis, the surgery is performed on highly vascularized tissues that are not easily sutured or cauterized (for example bone elements such as in spinal fusion or correction of craniosynostosis) or the surgery itself induces various disturbances of hemostasis (dilution of factors and induction of fibrinolysis as in cardiac surgery with the use of extracorporeal bypass). The pathology justifying the surgical procedure may also induce various coagulation and/or hemostatic abnormalities. Children suffering from congenital cardiac or liver dis- ease may have thrombocytopenia, abnormal platelet function (congenital heart disease) and/or inadequate amounts of various coagulation factors. Objectif1 Perioperative management of children with congenital coagulation and hemostatic diseases will not be discussed in this review. Developmental aspects of hemostasisAn excellent summary of the developmental physiology of coagulation, based mainly on the extensive work of Maureen Andrew, may be found in a recent review by Kuhle et al. and is summarized in Table I.2 Since maternal coagulation factors do not cross the placental barrier, blood levels measured at birth are the result of fetal synthesis that starts around the fifth week of gestation. Fetal blood becomes clottable around 11 weeks of gestation. Except fetal fibrinogen which has an increased content of sialic acid, all coagulation and inhibitor factors are qualitatively normal at birth, and differ from...

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“…Kan kaybı genelde total kan volümünün %10-20'sidir. Kan transfüzyonu başlangıç hematokritine, kan kaybının miktarına ve kardiyovasküler statusa bağlıdır 5,7,[21][22][23][24] . Postoperatif pediatrik yoğun bakımda monitorizasyon önerilir, mekanik ventilasyon desteği nadirdir.…”

Section: Tek Sütürlü Sinostozlarda Anesteziunclassified

“…Pron pozisyonunda cerrahi uygulanıyorsa baş yastıkla veya çivili başlıkla desteklenmeli, endotrakeal tüp korunmalıdır. Bu olgularda masif kan kaybı, İKB artışı ve venöz hava embolisi riskinde artış vardır 5,7,[21][22][23][24] . Cerrah ile anestezist iletişim halinde olmalıdır.…”

Section: Kompleks Sinostozlarda Anesteziunclassified

Pediyatrik Kraniofasiyal Cerrahide Anestezik Yaklaşım ve Kan Kaybını Azaltan Yöntemler

Biricik¹,

Güneş²

2015

Arşiv Kaynak Tarama Dergisi

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One of the most common craniofacial congenital abnormalities requiring surgery is craniosynostosis where there is premature fusion of one or more cranial sutures. A thorough assessment of the airway is necessary to enable careful planning of the anesthetic technique for craniofacial surgery. Pediatric craniofacial reconstruction procedures, has been associated with significant morbidity including cardiac arrest, massive transfusion, coagulopathy, severe hypotension, air embolism, largely related to blood loss. Transfusion of homologous blood is associated with significant and well-known risks. Reported transfusion rates for pediatric patients undergoing surgical correction of synostotic calvarial sutures vary between 20 and 500% of estimated blood volume. 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. In children undergoing surgical correction of craniosynostosis, pre-treated with erythropoietin, intraoperative tranexamic acid reduces transfusion requirement.

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Blood Loss During Repair of Craniosynostosis

Cited by 125 publications

References 1 publication

The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery

The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery

Réduire les pertes sanguines et les besoins transfusionnels en chirurgie pédiatrique

Pediyatrik Kraniofasiyal Cerrahide Anestezik Yaklaşım ve Kan Kaybını Azaltan Yöntemler

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