Comparison of Perioperative Anesthetic Concerns in Simple and Complex Craniosynostosis Cases: A Retrospective Study

Abstract

Background We compared intraoperative and postoperative anesthetic parameters between simple (S-single suture) and complex (C-more than one suture) craniosynostosis cases. Materials and Methods Data was collected from a retrospective review of anesthetic and postoperative records of patients who underwent craniosynostosis correction surgery between April 2014 and August 2019. Pearson’s chi-square and independent sample t-tests were used for analysis. Results We analyzed data of 98 patients (S-simple craniosynostosis: 40 and C-complex craniosynostosis: 58). Statistically significant differences between simple and complex cases were seen only in the incidence of difficult airway, failed extubation, and requirement of postoperative ventilation. Massive blood loss (S: 23.21 mL/kg; C: 22.71 mL/kg) and difficult airway (S: 2.04%; C: 19.39%) were the most common intraoperative adverse events encountered. Metabolic abnormalities, hemodynamic instability, and hypothermia occurred in few patients. The most common postoperative issue was pyrexia (S: 15.31%; C: 17.35%). Anemia and coagulopathy needing transfusion of blood products and vitamin K injection were seen in a significant number of cases. Three nonsyndromic patients developed seizures. Conclusion The incidence of difficult airway and failed extubation with postoperative ventilation is more frequent following surgery for complex craniosynostosis than simple craniosynostosis. Complications secondary to blood loss and airway issues were the primary cause of morbidity and mortality. A staged approach to surgical management resulted in decreased surgical blood loss among the children with complex craniosynostosis.

Epilepsy in Patients with Craniosynostosis: A Systematic Review

“…They also reported post-operative complications of hypotension, hypothermia, metabolic acidosis, blood loss, fever of unknown origin, and hyperglycemia [20]. The evaluation of incidents in the reported cohort showed clinically significant metabolic or hemodynamic events, despite the wide range of problems described in the literature [11,12,14,17,19,21,22]. These findings imply that those children require close monitoring for at least 24 hours following surgery.…”

“…A total of 11 studies were included in this review, with 21456 patients diagnosed with craniosynostosis, and more than half of them were males. Eight studies were conducted in the United States (USA) [10][11][12][13][14][15][16][17], one in Brazil [18], one in India [19], and one in Turkey [20]. We found that the nonsyndromic craniosynostosis weighed much more than the syndromic incidence.…”

“…Post-operative epilepsy was reported in seven studies; the highest rate (12.2%) [20] and the lowest (0.24%) [11]. Seven studies [10, 12-14, 17, 18, 20] found a high risk of bias, while four studies reported a moderate risk [11,15,16,19].…”

Anesthesia Management for Craniosynostosis Surgery

“…Ayrıca traneksamik asit plazmini inhibe eder. Traneksamik asitin 10 mg kg -1 bolus dozlarından sonra ameliyat süresince 5 mg kg -1 sa -1 infüzyon uygulamalarının pediatrik kraniyofasiyal ameliyatlarda kanamayı ve kan transfüzyonunu azalttığı, sistemik hemostazı etkilemeden D-dimer seviyesinde artışı önlediği gösterilmiştir (23,25). Traneksamik asit uygulamasının kan kaybını ve kan transfüzyonu sıklığını azalttığı, Zapata-Copete ve ark.…”

“…Hipervolemik hemodilüsyon, kan alınmadan viskozitenin sıvı yükleyerek azaltılması tekniğidir. Genellikle kolloid sıvı preoperatif dönemde 15 mL kg -1 yüklenir (14,23). Ameliyat sırasında gelişebilecek hipotermi koagülopatiye yol açacağından normoterminin sağlanması önemlidir (7,11).…”