Evaluation of Anesthesia and Transfusion in Craniosynostosis Surgery: A Retrospective Study

Öz

Aim:Craniosynostosis surgery is one of the difficult operations in terms of anesthesia and surgery, in which morbidity and mortality can be seen due to hypovolemia and hypothermia. In this study, general use of anesthesia and blood transfusion applied in craniosynostosis surgery of pediatric patients. Materials and Methods:The files of pediatric patients who had craniosynostosis surgery were evaluated.The demographic data including, hemoglobin and hematocrit values, the given volume of erythrocyte (ES) and fresh frozen plasma (FFP) suspension were recordedpre and post operatively. Results:The mean age was 8.4 months. All patients were given ES in the pediatric intensive care unit during the operation and 7 patients after the operation. TDP was given to 2 patients during the operation. The amount of ES given to the patients during the operation was 12.7 mL/kg (3-23) and the amount of ES given after the operation was 14.2 mL/kg (7.7-25.0). The mean operative time was 234 minutes. Conclusion:Careful and comprehensive follow-up of craniosynostosis surgery is required due to the high probability of bleeding during the operation, and the long anesthesia period. In addition, we think that packaging blood products according to pediatric age, weight and surgery would reduce donor exposure and cost.

Anahtar Kelimeler

• anesthesia
• hemorrhage
• transfusion
• Pediatric

Kraniosinostoz Cerrahisinde Anestezi ve Transfüzyonun Değerlendirilmesi: Retrospektif Çalışma

Öz

Amaç: Kraniosinostoz cerrahisi hipovolemi ve hipotermi nedeniyle morbidite ve mortalitenin görülebildiği, anestezi ve cerrahi açıdan riskli ameliyatlardandır. Çalışmada pediyatrik hastaların kraniosinostoz cerrahisinde uygulanan anestezi ve kan transfüzyonunun genel kullanımını değerlendirdik. Gereç ve Yöntem: Kraniosinostoz cerrahisi geçiren çocuk hastaların medikal kayıtları değerlendirildi. Hemoglobin ve hematokrit değerleri, verilen eritrosit (ES) hacmi ve taze donmuş plazma (TDP) süspansiyonunu içeren demografik veriler ameliyat öncesi ve sonrası kaydedildi. Bulgular: Ortalama yaş 8.4 ay idi. Hastaların tümüne operasyon sırasında, 7 hastaya operasyondan sonra çocuk yoğun bakımda ES verildi. TDP operasyon sırasında 2 hastaya verildi. Hastalara operasyon sırasında verilen ES miktarı 12.7 mL/kg (3-23), operasyon sonrası verilen ES miktarı ise 14.2 mL/kg (7.7-25.0) idi. Ortalama operasyon süresi 234 dakika idi. Sonuç: Kraniosinostoz cerrahisinde yüksek kanama ihtimali, uzun anestezi süresi nedeniyle dikkatli ve kapsamlı hasta takibi yapılması gerekmektedir. Ayrıca kan ürünlerinin pediyatrik yaş, kilo ve yapılacak cerrahiye göre ambalajlanmasının donör maruziyeti ve maliyeti azaltacağını düşünmekteyiz.

Anahtar Kelimeler

• anestezi
• kanama
• transfüzyon
• Pediyatrik

Kaynakça

1. Ali A, Basaran B, Yornuk M, Altun D, Aydoseli A, Sencer A, Akinci IO. (2013). Factors influencing blood loss and postoperative morbidity in children undergoing craniosynostosis surgery: a retrospective study.Pediatric neurosurgery 49 (6), 339-46. https://doi.org/10.1159/000368781
2. Bajwa SS, Kulshrestha A. (2014). Craniofacial and maxillary anomalies: Anaestetic implications and management. J Sci Sov 41:73-78. https://doi.org/ 10.4103/0974-5009.132819
3. Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC. (2011).The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes. Am J Med. Oct;124(10):970–76. https://doi.org/10.1016/j.amjmed.2011.04.032
4. Bayık M, Uluhan R, Heper R. (2015).XVIII. Ulusal Kan Merkezleri ve Transfüzyon Tıbbı Kurs Kitabı. İstanbul: Yatay Ofset. Bellew M, Chumas P. (2015).Long-term developmental follow-up in children with nonsyndromic craniosynostosis. J. Neurosurg Pediatr 16 (4): 445-51.https://doi.org/10.3171/2015.3.PEDS14567
5. Choi JW, Lim SY, Shin HJ. (2016).Craniosynostosis in Growing Children: Pathophysiological Changes and Neurosurgical ProblemsJ Korean Neurosurg Soc. 59 (3): 197-203.https://dx.doi.org/10.3340%2Fjkns.2016.59.3.197
6. Cornelissen M, Ottelander B, Rizopoulos D, Hulst R, Molen AM, Horst C, Delye H, Veelen ML, Bonsel G, Mathijssen I.(2016). Increase of prevalence of craniosynostosis. Journal of Cranio-Maxillofacial Surgery. 44(9):1273-79.https://doi.org/10.1016/j.jcms.2016.07.007
7. Czerwinski M, Hopper RA, Gruss J, Fearon FA. (2010). Major morbidity and mortality rates in craniofacial Surgery: An Analysis of 8101 major procedures. Plast Recons Surg. 126(1): 181-86.https://doi.org/10.1097/prs.0b013e3181da87df
8. Çeltikçi E, Börcek AÖ, Baykener MK. (2013). Kraniyosinostozlar. Türk Nöroşirurji Dergisi.23:132-37.

9. Forvet PA, Lin EE, Fiadjoe JE, Sussman EM , Pruitt EY, Zhao H et al. (2013). Evaluation of central venous pressure monitoring in children undergoing craniofacial reconstruction surgery. Anesth Analg. 116:411-20.https://doi.org/10.1213/ane.0b013e31827008e6
10. Goobie SM, Meier PM, Pereira LM, McGowan FX, Prescilla RP, Scharp LA, Rogers GF, Proctor MR, Meara JG, Soriano SG, Zurakowski D, Sethna NF.(2011). Efficacy of tranexamic acid in pediatric craniosynostosis surgery. Anesthesiology 114: 862- 71. https://doi.org/10.1097/aln.0b013e318210fd8f
11. Han RH, Nguyen DC, Bruck BS, Skolnick GB, Yarbrough CK, Naidoo SD, Patel KB, Kane AA, Woo AS, Symyth M.(2016). Characterisation of complications associated with open and endoscopic craniosynostosis surgery at single institution. J Neurosurg Pediatr 17(3):361-70.https://doi.org/10.3171/2015.7.peds15187
12. Jacquot C, Delaney M. (2018). Pathogen-inactivated blood products for pediatric patients: blood safety, patient safety, or both? Transfusion.58(9):2095-2101. https://doi.org/10.1111/trf.14811
13. Jain A, Sponseller PD, Newton PO, Shah SA, Cahill PJ, Njoku DB, Betz RR, Samdani AF,Bastrom TP, Marks MC, Harms Study G. (2015). Smaller body size increases the percentage of blood volume lost during posterior spinal arthrodesis. J Bone Joint Surg Am.97(6):507–11https://doi.org/10.2106/jbjs.n.01104
14. Ko JM.(2016). Genetic syndromes associated with craniosynostosis. J Korean Neurosurg Soc 59(3):187-91. https://doi.org/10.3340/jkns.2016.59.3.187
15. Lee J, Radulescue V, Porhomayon J, Pourafkari L, Arora P, Dosluoglu HH, et al. (2015). The role of perioperative transfusion on long-term survival of veterans undergoing surgery. Ann Surg. Jan;261 (1):104–10. https://doi.org/10.1159/000497826
16. Meier J, Filipescu D, Kozek-Langenecker S, Llau Pitarch J, Mallett S, Martus P, et al. (2016). Intraoperative transfusion practices in Europe.. Br J Anaesth. Feb; 116 (2) :255–61.https://doi.org/10.1093/bja/aev456
17. Nargozian C. (2004). The airway in patients with craniofacial abnormalities. Paediatr Anaesth 14: 53-59.DOI: 10.1046/j.1460-9592.2003.01200.x
18. Nguyen TT, Lam HV, Phillips M, Edwards C, Austin TM. (2015). Intraoperative optimization to decrease postoperative PRBC transfusion in children undergoing craniofacial reconstruction. Paediatr Anaesth 25(3): 294-300. DOI: 10.1111/pan.12600
19. New H, Berryman J, Bolton-Maggs P, Cantwell C, Chalmers EA, Davies T, Gottstein R, Kelleher A, Kumar S, Morley SL, Stanworth SJ. (2016). British Committee for Standards in Haematology Guidelines on transfusion for fetuses, neonates and older children. Br J Haematol. 175:784–828. https://doi.org/10.1111/bjh.14233
20. Pieters BJ, Singhal VK. (2012). Does early administration of fresh frozen plasma (FFP) in the operating room decrease blood loss and transfusion needs? Plast Reconst Surg. 130:67-70.https://doi.org/10.17827/aktd.24404
21. Raja RA, Khemani VD, Sheikh S, Khan H. (2011). Craniosynostosis: Early recognition prevents fatal complications. J Ayub Med Coll Abbottabad 23: 140-43.
22. Thomas K, Hughes C, Johnson D, Das S. (2012). Anesthesia for surgery related to craniosynostosis: a review. Part 1.Pediatr Anesth. 22:1033–41. TT, Lam HV, Phillips M, Edwards C, Austin TM.(2015). Intraoperative optimization to decrease postoperative PRBC transfusion in children undergoing craniofacial reconstruction. Paediatr Anaesth 25(3): 294-300. https://doi.org/10.1111/j.1460-9592.2012.03927.x
23. White N, Bayliss S, Moore D. (2015). Systematic review of interventions for minimizing perioperative blood transfusion for surgery for craniosynostosis. J Craniofac Surg. 26: 26–36. https://doi.org/10.1097/SCS.0000000000001108
24. Van Uitert A, Megens JH, Breugem CC, Stubenitsky BM, Han KS, de Graaff JC. (2011). Factors influencing blood loss and allogeneic blood transfusion practice in craniosynostosis surgery. Paediatr Anaesth 21:1192–97. https://doi.org/10.1159/000368781