Perioperative outcomes and management in midface advancement surgery: a multicenter observational descriptive study from the Pediatric Craniofacial Collaborative Group

Glover, Chris D.; Fernández, Allison M.; Huang, Henry; Derderian, Christopher A.; Binstock, Wendy; Reid, Russell R.; Dalesio, Nicholas M.; Zhong, John; Stricker, Paul A.

doi:10.1111/pan.13418

Cited by 14 publications

(10 citation statements)

References 31 publications

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“…When we evaluated the intraoperative fluid management of these patients undergoing Monobloc distraction; we observed that no colloid was given, yet a high amount of blood was transfused (52%; 40 ml.kg −1 , 35%; 60 ml.kg −1 and 17%; 80 ml.kg −1 ). More restrictive transfusion practices have been recommended in this population to reduce complications and improve patient safety 29 …”

Section: Discussionmentioning

confidence: 99%

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The Relevance of Fluid and Blood Management Using Microcirculatory Parameters in Children Undergoing Craniofacial Surgery

Kılıçaslan¹,

Canbay²,

Şaylan³

et al. 2021

Journal of Craniofacial Surgery

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Perioperative management of bleeding in children can be challenging. Microvascular imaging techniques have allowed evaluating the effect of blood transfusion on the microcirculation, but little is known about these effects in children. We aimed to investigate the effects of blood management using macro-and micro-hemodynamic parameters measurement in children undergoing craniofacial surgery. This is a prospective observational repeated measurement study including fourteen children. The indications for blood transfusion were changes of hemoglobin/ hematocrit (Hct) levels, the presence of signs of altered tissue perfusion and impaired microcirculation images. Total and perfused vessel densities, proportion of perfused vessels, microvascular flow index, and systemic parameters (hemoglobin, Hct, lactate, mixed venous oxygen saturation, K þ , heart rate, mean arterial blood pressure) were evaluated baseline (T1), at the end of the surgical bleeding (T2) and end of the operation (T3). Four patients did not need a blood transfusion. In the other 10 patients who received a blood transfusion, capillary perfusion was higher at T3 (13[9 -16]) when compared with the values of at T2 (11[8 -12]) (P < 0.05) but only 6 patients reached their baseline values.Although blood transfusions increased Hct values (17 AE 2.4 [T2]-19 AE 2.8 [T3]) (P < 0.05), there was no correlation between microvascular changes and systemic hemodynamic parameters (P > 0.05). The sublingual microcirculation could change by blood transfusion but there was not any correlation between microcirculation changes, hemodynamic, and tissue perfusion parameters even with Hct values. The indication, guidance, and timing of fluid and blood therapy may be assessed by bedside microvascular analysis in combination with standard hemodynamic and biochemical monitoring for intraoperative bleeding in children.

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Section: Discussionmentioning

confidence: 99%

“…More restrictive transfusion practices have been recommended in this population to reduce complications and improve patient safety. 29…”

Section: Figurementioning

confidence: 99%

The Relevance of Fluid and Blood Management Using Microcirculatory Parameters in Children Undergoing Craniofacial Surgery

Kılıçaslan¹,

Canbay²,

Şaylan³

et al. 2021

Journal of Craniofacial Surgery

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“…However, clinician experience supported by several retrospective studies identified some physical risk factors for a difficult airway in neonates and infants: micro-, retro-, or prognathia, limited mouth opening, facial asymmetry, fixed cervical spine, labio-palatine cleft, and oral or neck mass 10–12 . These physical features commonly exist in neonates and infants with syndromes associated with anticipated difficult airway management such as the Pierre Robin, Crouzon, and Treacher-Collins syndromes 11,13 . However, there are no studies prospectively evaluating the role of physical features in predicting difficult airway management (mask ventilation or tracheal intubation) in neonates and infants with an apparently normal airway.…”

Section: Methodsmentioning

confidence: 99%

“…[10][11][12] These physical features commonly exist in neonates and infants with syndromes associated with anticipated difficult airway management such as the Pierre Robin, Crouzon, and Treacher-Collins syndromes. 11,13 However, there are no studies prospectively evaluating the role of physical features in predicting difficult airway management (mask ventilation or tracheal intubation) in neonates and infants with an apparently normal airway. While several adult based studies have suggested simple summations or weighted risk scores for predicting 'unanticipated' difficult tracheal intubation based on physical measures (e.g.…”

Section: Development Of Recommendationsmentioning

confidence: 99%

Airway management in neonates and infants

Disma,

Asai,

Cools

et al. 2023

European Journal of Anaesthesiology

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Airway management is required during general anaesthesia and is essential for life-threatening conditions such as cardiopulmonary resuscitation. Evidence from recent trials indicates a high incidence of critical events during airway management, especially in neonates or infants. It is important to define the optimal techniques and strategies for airway management in these groups. In this joint European Society of Anaesthesiology and Intensive Care (ESAIC) and British Journal of Anaesthesia (BJA) guideline on airway management in neonates and infants, we present aggregated and evidence-based recommendations to assist clinicians in providing safe and effective medical care. We identified seven main areas of interest for airway management: i) preoperative assessment and preparation; ii) medications; iii) techniques and algorithms; iv) identification and treatment of difficult airways; v) confirmation of tracheal intubation; vi) tracheal extubation, and vii) human factors. Based on these areas, Population, Intervention, Comparison, Outcomes (PICO) questions were derived that guided a structured literature search. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology was used to formulate the recommendations based on those studies included with consideration of their methodological quality (strong ‘1’ or weak ‘2’ recommendation with high ‘A’, medium ‘B’ or low ‘C’ quality of evidence). In summary, we recommend: 1. Use medical history and physical examination to predict difficult airway management (1С). 2. Ensure adequate level of sedation or general anaesthesia during airway management (1B). 3. Administer neuromuscular blocker before tracheal intubation when spontaneous breathing is not necessary (1С). 4. Use a videolaryngoscope with an age-adapted standard blade as first choice for tracheal intubation (1B). 5. Apply apnoeic oxygenation during tracheal intubation in neonates (1B). 6. Consider a supraglottic airway for rescue oxygenation and ventilation when tracheal intubation fails (1B). 7. Limit the number of tracheal intubation attempts (1C). 8. Use a stylet to reinforce and preshape tracheal tubes when hyperangulated videolaryngoscope blades are used and when the larynx is anatomically anterior (1C). 9. Verify intubation is successful with clinical assessment and end-tidal CO2 waveform (1C). 10. Apply high-flow nasal oxygenation, continuous positive airway pressure or nasal intermittent positive pressure ventilation for postextubation respiratory support, when appropriate (1B).

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“…To our knowledge, there is currently no large, published case series of perioperative airway complications and management in patients with Crouzon and Pfeiffer syndromes. Most of the current published literature is limited to single case reports relating to anesthetic management 6–8 or larger series focusing on craniofacial surgical complications 9,10 …”

Section: Introductionmentioning

confidence: 99%

Perioperative airway complications in infants and children with Crouzon and Pfeiffer syndromes: A single‐center experience

Raman

Beer

2021

Pediatric Anesthesia

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Background Crouzon and Pfeiffer syndromes are rare genetic disorders characterized by craniosynostosis, exorbitism, and maxillary hypoplasia. Patients with these syndromes frequently require general anesthesia for various diagnostic and surgical procedures and may present a challenge to anesthetists with regard to airway management. Aims The primary aim of this study was to determine the incidence, timing, and management of perioperative upper airway obstruction in infants and children with Crouzon and Pfeiffer syndromes. The secondary aim was to determine the degree of difficulty in performing endotracheal intubation. Methods A retrospective review of 812 anesthetic encounters in 67 patients was conducted. The following were recorded: timing and management of episodes of perioperative upper airway obstruction, from induction of anesthesia to discharge from recovery, degree of difficulty with laryngoscopy using the Cormack‐Lehane grading system and number of intubation attempts required, patient demographics, respiratory comorbidity, surgical procedure, and anesthetic airway management techniques. Results Upper airway obstruction at induction of anesthesia was very common, with an incidence of 31% (167/542 anesthetic encounters affecting 54 patients). In a quarter of these incidents, bag‐valve‐mask ventilation was challenging, but a laryngeal mask airway was almost always effective. Upper airway obstruction on emergence from anesthesia was less common, with an incidence of 2.7% (14/515 anesthetic encounters affecting 10 patients). Contributing factors included patient comorbidity (obstructive sleep apnea, nasal stenosis) and the nature of surgery (craniofacial or airway procedures). Intubation was rarely difficult in this cohort, with 85% of laryngoscopies rated Cormack‐Lehane grade 1 or 2 (n = 373), and 89% of intubations successful on the first attempt (n = 306). Conclusions Upper airway obstruction at induction of anesthesia is common in patients with Crouzon and Pfeiffer syndrome. These patients are likely to present some difficulties with perioperative airway management, especially bag‐valve‐mask ventilation, but rarely endotracheal intubation.

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Perioperative outcomes and management in midface advancement surgery: a multicenter observational descriptive study from the Pediatric Craniofacial Collaborative Group

Abstract: Monobloc procedures were associated with greater transfusion and longer ICU and hospital length of stay. Perioperative complications were more prevalent in the Monobloc group.

Cited by 14 publications

References 31 publications

The Relevance of Fluid and Blood Management Using Microcirculatory Parameters in Children Undergoing Craniofacial Surgery

The Relevance of Fluid and Blood Management Using Microcirculatory Parameters in Children Undergoing Craniofacial Surgery

Airway management in neonates and infants

Perioperative airway complications in infants and children with Crouzon and Pfeiffer syndromes: A single‐center experience

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