The management of blood loss in non-syndromic craniosynostosis patients undergoing barrel stave osteotomy

Abstract

ABSTRACTare used in an attempt to keep the body temperature stable and it may be monitored continuously by a probe. However, it is nearly impossible to objectively evaluate the amount of bleeding in the calvarium while undergoing a barrel stave osteotomy. Therefore, the intraoperative observations of the surgeon, his experience, and his communication with the anesthetist and monitoring of vital signs are important in determining perioperative blood and fluid losses (13).Our aim was to evaluate blood loss and administration of blood products in patients being operated on to treat craniosynostosis, while taking age, body weight, type of craniosynostosis, preoperative and postoperative hemoglobin and hematocrit levels in to consideration. █ INTRODUCTION C raniosynostosis is the early and pathologic closure of one or more sutures in the cranium, generally causing an abnormal appearance (21). Although craniosynostosis cases are referred to a physician for cosmetic reasons, the main aim of neurosurgeons in treating craniosynostosis is to relieve an increase in potential intracranial pressure on the neural tissues and prevent and or treat disorders of cognitive function. Thus, a widely used procedure in neurosurgery, barrel stave osteotomy, is applied to the majority of craniosynostosis cases. Hypothermia and hypovolemia are the most important causes of morbidity and mortality in surgical interventions of craniosynostosis (18). During surgery, heating blankets AIm: Barrel stave osteotomy is a widely used procedure in neurosurgery for the majority of craniosynostosis patients. Both in the intraoperative and postoperative periods, there is inevitable leakage type bleeding from the bones undergoing osteotomy. A number of studies have been performed in order to prevent this complication but a concise procedure is still lacking. mATERIAl and mEThODS: Synostectomy and parietotemporal barrel stave osteotomy were applied to 143 patients who were operated on with a diagnosis of craniosynostosis between the years 2005-2013. At the beginning to osteotomy, 5 ml/kg erythrocyte suspension (ES) was given for probable blood loss. Whole blood count was performed at the postoperative 1 st and 6 th hours and cases with hemoglobin levels below 10 or with hematocrit levels which had decreased more than 5% between the 1 st and 6 th hours were administered erythrocyte transfusion. RESUlTS:Of the patients, 100 were boys and 43 were girls. Of these, 98 had metopic, 30 had sagittal, 9 had metopic+sagittal, 4 had unilateral, 2 had bilateral and 6 had coronal synostosis. All the cases were administered intraoperative erythrocyte suspension. The preoperative amount of administered mean erythrocyte was 8.61 ml/kg. In the postoperative period, 92 patients were administered erythrocyte suspension. The postoperative amount of administered mean erythrocyte suspension was 7.98 ml/kg. CONClUSION:For an operated infant with craniosynostosis who is operated on in the first year of life, undergoing osteotomy and inevitable bone-borne blood losses are very i...

Perioperative Anaesthetic Management of Pediatric Patients in Craniosynostosis

“…During the operation, an average of 165.88 ml (30-440 ml) erythrocyte suspension was transfused to the patients. In the study conducted by Küçük et al (18) the average amount of ES given to patients was 61.2 ml (15-200), while Chocron et al (19) used an average of 29.6 cc/kg in their study with 100 cases. In the studies of Jeong et al (2) the mean blood transfusion was determined as 1293 ml.…”

Optimizing Blood Loss and Management in Craniosynostosis Surgery: A Systematic Review of Outcomes Over the Last 40 Years

“…Historically, it was considered that blood transfusions in this patient population were inevitable to accomplish this 19 with even the most experienced craniofacial centers reporting transfusion rates as high as 80% to 100%. [10][11][12][13][14] However, autogenic and allogenic transfusions are not without risk, including infection, allergy, or even transfusing with incorrectly crossmatched blood. Thus, it is crucial that the perioperative surgical experience aims to reduce blood loss and the subsequent need for transfusion exposure.…”

“…[5][6][7][8] However, in these extensive procedures, blood loss can be greater than 100% of the total circulating volume. 8,9 The rate of allogenic blood transfusion has been reported to be as high as 100% [10][11][12][13][14] and up to 500% of estimated blood volume. 15 Thus, with the risk of shock and hemorrhage, surgery carries a mortality rate of up to 1%.…”

Epidemiologic and Surgical Approach of Cranyosynostosis: A Case of Madagascar and Review of Literature

“…Selon Chow et al [26], le volume de la transfusion sanguine moyenne devrait être de l'ordre de 25ml/kg ; au-delà de 60ml/kg, il y a un risque majeur de complications post-opératoires. Dans la série de Kucuk [15], il faut administrer du culot globulaire de 8.61 ml/kg en moyenne en per-opératoire et 7.98 ml/kg en post-opératoire.…”