Anesthetic Management of Pediatric Craniofacial Surgery and Methods of Reducing Blood Loss

Year 2015, Volume: 24 Issue: 1, 1 - 18, 17.11.2014

Ebru Biricik Yasemin Güneş

https://doi.org/10.17827/aktd.24404

Abstract

One of the most common craniofacial congenital abnormalities requiring surgery is craniosynostosis where there is premature fusion of one or more cranial sutures. A thorough assessment of the airway is necessary to enable careful planning of the anesthetic technique for craniofacial surgery. Pediatric craniofacial reconstruction procedures, has been associated with significant morbidity including cardiac arrest, massive transfusion, coagulopathy, severe hypotension, air embolism, largely related to blood loss. Transfusion of homologous blood is associated with significant and well-known risks. Reported transfusion rates for pediatric patients undergoing surgical correction of synostotic calvarial sutures vary between 20 and 500% of estimated blood volume. Attempts at reducing exposure to allogeneic transfusions, using blood conservation techniques such as controlled hypotension and normovolemic hemodilution, have met with mixed results and are not always practical in small infants. In children undergoing surgical correction of craniosynostosis, pre-treated with erythropoietin, intraoperative tranexamic acid reduces transfusion requirement.

Keywords

Craniosynostosis, blood loss, erythropoietin, Tranexamic Acid, otologous transfusion

Pediyatrik Kraniofasiyal Cerrahide Anestezik Yaklaşım ve Kan Kaybını Azaltan Yöntemler

Abstract

Cerrahi gerektiren en yaygın kraniofasiyal konjenital amomalilerden biri olan kraniyosinostozis bir veya daha fazla kafa sütürünün erken füzyonudur. Kraniyofasiyal cerrahi için anestezik teknik planlanırken detaylı bir şekilde havayolunun değerlendirilmesi gereklidir. Pediatrik kraniofasiyal düzeltme işlemleri büyük ölçüde kan kaybına bağlı olarak kardiyak arrest, masif transfüzyon, koagülopati, şiddetli hipotansiyon, hava embolisi, dahil olmak üzere önemli morbiditeye sahiptir. Homolog kan transfüzyonu önemli ve iyi bilinen risklerle birliktedir. Sinostotik kalvaryal sütürde cerrahi düzeltme uygulanan pediyatrik hastalarda bildirilen transfüzyon oranları tahmini kan hacminin %20-%500’ ü arasında değişmektedir. Kontrollü hipotansiyon ve normovolemik hemodilüsyon gibi kan koruma teknikleri gibi allojenik transfüzyonu azaltma girişimlerinde karmaşık sonuçlar alınmıştır ve küçük bebeklerde uygulanması her zaman pratik değildir. Kraniyosinostozlarda cerrahi düzeltme yapılan çocuklarda, eritropoietin ile önceden tedavi, ameliyat sırasındaki traneksamid asit uygulaması transfüzyon gereksinimini azaltmaktadır.

Keywords

Kranisinostozis, kan kaybı, eritropoietin, traneksamik asit, otolog transfüzyon

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• Correspondence Address / Yazışma Adresi Ebru Biricik
• Çukurova Üniv. Tıp Fakültesi
• Anesteziyoloji ve Reanimasyon Anabilim Dalı. Adana, Turkey
• e-mail: [e-mail]