Improved Intraoperative Hemodynamics in Burn Surgery: An Institutional Change to Pediatric-Specific Hemostasis Solutions

Abstract

A cornerstone of burn surgery hemostasis is infiltration of tumescent vasopressor solutions and topical vasoconstrictor-soaked compresses. Studies detailing pediatric-specific concentrations of these solutions are lacking. Our aim was to assess hemodynamic changes after an institutional change in tumescent vasopressor solution and vasopressor-soaked topical compresses for hemostasis management during pediatric burn surgery. Once the institutional change was implemented, cases performed before and after the intervention were reviewed; inclusion criteria included age 0-18 years, burn total body surface area (TBSA) ≥ 10%, and surgery length >50 minutes. Primary outcomes included changes in intraoperative mean arterial pressure, maximum inhaled anesthetic concentration, need for direct acting vasodilators, estimated blood loss and need for blood transfusions. 30 patients were included in the intervention group, and 31 in the control group. There was a significant difference in peak intraoperative blood pressure in the intervention group (21.4%) compared to the control group (48.0%, p=0.005). Maximum inhaled anesthetic concentrations were lower in the intervention group (2.5% versus 2.8%, p=0.02). Estimated blood loss per TBSA decreased significantly (8.2 mL/1% TBSA versus 1.7, p=0.008), as well as blood transfusion rates, with a transfusion rate of 16.7% in the intervention group versus 45.2% in the control group (p=0.03). The changes instituted in type and concentration of tumescent solution and vasopressor-soaked topical compresses were associated with improved hemodynamic changes and decreased transfusion rates intraoperatively.