Anaesthetic management in facial bipartition surgery: The experience of one centre

Abstract

SummaryFacial bipartition is amongst the most radical craniofacial surgery undertaken but is performed rarely. There is little published information on its anaesthetic management. We undertook a retrospective case-note review of 22 consecutive patients undergoing bipartition surgery by the same surgical team in one centre in the period 1993-2001. There were incomplete data for two cases and these were therefore excluded. Patients were aged 2 months to 19 years. Conditions treated were facial cleft (n = 5), frontonasal dysplasia (n = 7) and facial dysostosis (n = 8). Intra-operative complications included major haemorrhage (n = 4), bradycardia (n = 3) and unintentional tracheal extubation (n = 1). There were no peri-operative deaths. All patients required intra-operative blood transfusion and 15% of them had a postoperative haemoglobin concentration > 115% of their pre-operative value. In this series, four patients required postoperative lung ventilation for a median duration of 3 days. Infants < 14 months old were significantly more likely to receive a massive blood transfusion (p = 0.0002), to have an excessively high postoperative haematocrit (p = 0.008) and to require postoperative lung ventilation (p = 0.0002) compared with older patients. We conclude that patients in this age group have a significantly increased risk of postoperative complications.

Metabolic changes during major craniofacial surgery

“…This type of surgery is often performed at an early age and is associated with prolonged operating times, extensive operative exposure, and significant heat and blood loss (3,4). Estimation of intraoperative blood loss in patients undergoing craniosynostosis repair is often inaccurate and significantly underestimates actual blood loss (5,6). Almost all patients undergoing repair of craniofacial deformities will need a blood transfusion with potential for massive blood transfusion (4).…”

Perioperative complications in children with Apert syndrome: a review of 509 anesthetics

“…There are very little published data looking specifically at perioperative outcomes in children with Apert syndrome. Reviews and reports tend to group them together with other craniofacial syndromes (11–13), so specific complications may be masked. Our institution has records of 71 children with Apert syndrome diagnosed clinically and genetically.…”