Anaesthesia in craniosynostosis

Abstract

Craniosynostosis is a congenital disorder requiring extensive reconstructive surgery that entails a high probability of severe bleeding, massive transfusion and difficult airway management. Considering that the anaesthetic management for this procedure has special requirements and priority targets, presenting the experience of the anaesthesiology department working under the programme for surgery of craniofacial abnormalities is of the greatest importance. ObjectiveDescribe the behaviour of anaesthetic variables during the perioperative period in patients taken to craniosynostosis correction at Hospital Infantil Universitario de San José. MethodsRetrospective observational cohort study in patients taken to surgery between January 1st 2008 and January 31st 2012. Data were collected from electronic clinical records and anaesthesia records. ResultsThe most relevant data were haemorrhage and transfusion. Blood loss was 35.6cc/kg (SD=17.4), considered as severe haemorrhage. Patients receiving tranexamic acid did not show lower intra-operative levels of blood loss or packed red blood cell (PRBC) transfusions, shorter mechanical ventilation or ICU (intensive care unit) length of stay. We observed a smaller number of PRBC transfusions in patients in the ICU who received desmopressin. ConclusionsWe suggest that neither tranexamic acid (14mg/kg) nor desmopressin (0.36mg/kg) in this cohort correlated with reduced haemorrhage or smaller volumes of intra-operative PRBCs. We only describe a smaller volume of transfused PRBCs in the ICU associated with the use of desmopressin.