Pediatric perioperative bleeding – Basic considerations

Abstract

Massive perioperative bleeding following major surgery or trauma is one of the main causes of preventable morbidity and mortality in the pediatric patient. Non-surgical or coagulopathic bleeding may be caused by a congenital or acquired coagulation disorder that was undetected prior to surgery, by disorders in the coagulation cascade resulting from specific surgical interventions such as liver transplantation or cardiopulmonary bypass to repair congenital heart diseases or when massive blood losses develop as in children with severe multiple trauma, major surgery, craniosynostosis and scoliosis. Hence, their management requires adequate preoperative evaluation to identify the children at high risk of bleeding and thus be always prepared for massive intraoperative bleeding, in addition to perform early interventions to prevent the multiple complications of coagulopathy in hemorrhagic shock, such as hypothermia, acidosis and hemodilution.