Predictors of Blood Loss in Fronto-Orbital Advancement and Remodeling

White, Nicholas J.; Marcus, R.; Dover, Stephen; Solanki, Guirish A.; Nishikawa, Hiroshi; Millar, Carol; Carver, Edmund D.

doi:10.1097/scs.0b013e31819b9429

Cited by 87 publications

(63 citation statements)

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“…Blood loss during major craniosynostosis surgery has been reported to vary considerably based on the numbers of sutures involved, the length of surgical time, the age at time of surgery, and the presence of craniofacial syndromes. 16 Notably, the observed blood loss in our early intervention group (median 90%) is markedly below the data of the aforementioned study, which reports a blood loss of 148% of estimated total blood volume for multiple sutures, and 110% if mono suture or bicoronal synostosis surgery was performed. To further emphasize the effectiveness of the applied management investigated in this study, no postoperative RBC transfusion in any child was necessary.…”

Section: Discussioncontrasting

confidence: 42%

Higher fibrinogen concentrations for reduction of transfusion requirements during major paediatric surgery: A prospective randomised controlled trial

Haas

Spielmann

Restin

et al. 2015

British Journal of Anaesthesia

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BACKGROUND: Hypofibrinogenaemia is one of the main reasons for development of perioperative coagulopathy during major paediatric surgery. The aim of this study was to assess whether prophylactic maintenance of higher fibrinogen concentrations through administration of fibrinogen concentrate would decrease the volume of transfused red blood cell (RBCs). METHODS: In this prospective, randomised, clinical trial, patients aged 6 months to 17 yr undergoing craniosynostosis and scoliosis surgery received fibrinogen concentrate (30 mg kg(-1)) at two predefined intraoperative fibrinogen concentrations [ROTEM(®) FIBTEM maximum clot firmness (MCF) of <8 mm (conventional) or <13 mm (early substitution)]. Total volume of transfused RBCs was recorded over 24 h after start of surgery. RE-SULTS: Thirty children who underwent craniosynostosis surgery and 19 children who underwent scoliosis surgery were treated per protocol. During craniosynostosis surgery, children in the early substitution group received significantly less RBCs (median, 28 ml kg(-1); IQR, 21 to 50 ml kg(-1)) compared with the conventional fibrinogen trigger of <8 mm (median, 56 ml kg(-1); IQR, 28 to 62 ml kg(-1)) (P=0.03). Calculated blood loss as per cent of estimated total blood volume decreased from a median of 160% (IQR, to a median of 90% (IQR, 78-110%) (P=0.017). No significant changes were observed in the scoliosis surgery population. No bleeding events requiring surgical intervention, postoperative transfusions of RBCs, or treatment-related adverse events were observed. CONCLUSIONS: Intraoperative administration of fibrinogen concentrate using a FIBTEM MCF trigger level of <13 mm can be successfully used to significantly decrease bleeding, and transfusion requirements in the setting of craniosynostosis surgery, but not scoliosis. CLINICAL TRIAL REGISTRY NUMBER: ClinicalTrials.gov NCT01487837. AbstractBackground: Hypofibrinogenaemia is one of the main reasons for development of perioperative coagulopathy during major paediatric surgery. The aim of this study was to assess whether prophylactic maintenance of higher fibrinogen concentrations through administration of fibrinogen concentrate would decrease the volume of transfused red blood cell (RBCs). Methods: In this prospective, randomised, clinical trial, patients aged 6 months to 17 yr undergoing craniosynostosis and scoliosis surgery received fibrinogen concentrate (30 mg kg

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Section: Discussioncontrasting

confidence: 42%

Higher fibrinogen concentrations for reduction of transfusion requirements during major paediatric surgery: A prospective randomised controlled trial

Haas

Spielmann

Restin

et al. 2015

British Journal of Anaesthesia

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“…However, it is not the only major determinant, as it is well known that certain highrisk groups, such as those with recognized craniofacial syndromes, pansynostosis, operating time greater than 5 h, and age of 18 months or younger at the time of the procedure, have significantly greater blood loss during craniosynostosis repair. 8 Furthermore, our study and other studies support the fact that there is an inverse relationship between the child's age and the amount of blood loss and transfusion requirements during craniosynostosis reconstructive surgery. 6,8 -10 Blood loss during craniosynostosis surgery may seem to be disproportionately greater in infants (less than 10 kg) than older children because the head represents a larger percentage of total body surface area.…”

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confidence: 75%

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Joshi¹

2012

Anesthesiology

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“…During surgical procedures, elongation of surgical time is the most important factor that influences bleeding (26). Thus, the experience of the surgical team may reduce the duration of surgery and also indirectly reduce the bleeding.…”

Section: █ Discussionmentioning

confidence: 99%

“…However, in the literature there are many studies with significantly longer surgical times (2,13,24,26). White et al (26), reported a mean surgical time of 5.11 hours in their study determining the markers of blood loss in frontoorbital advancement remodeling surgery. Kang et al (13) reported a mean surgical time of 3.5 hours in their study on the management of blood loss in craniosynostosis surgery.…”

Section: █ Discussionmentioning

confidence: 99%

“…The mean amount of intraoperative ES was 61.2 ml (15-200 ml). White et al (26), in their study with 116 cases, administered more than 300 ml ES and used intraoperative fibrin glue in order to decrease postoperative bleeding. Shah et al (20), in their study comparing endoscopic and open methods, found mean blood amount given intraoperatively as 218 ml in the open method with 89 cases undergoing barrel stave osteotomy.…”

Section: █ Discussionmentioning

confidence: 99%

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The management of blood loss in non-syndromic craniosynostosis patients undergoing barrel stave osteotomy

Küçük

Tümtürk²,

Gergin³

et al. 2015

Turkish Neurosurgery

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ABSTRACTare used in an attempt to keep the body temperature stable and it may be monitored continuously by a probe. However, it is nearly impossible to objectively evaluate the amount of bleeding in the calvarium while undergoing a barrel stave osteotomy. Therefore, the intraoperative observations of the surgeon, his experience, and his communication with the anesthetist and monitoring of vital signs are important in determining perioperative blood and fluid losses (13).Our aim was to evaluate blood loss and administration of blood products in patients being operated on to treat craniosynostosis, while taking age, body weight, type of craniosynostosis, preoperative and postoperative hemoglobin and hematocrit levels in to consideration. █ INTRODUCTION C raniosynostosis is the early and pathologic closure of one or more sutures in the cranium, generally causing an abnormal appearance (21). Although craniosynostosis cases are referred to a physician for cosmetic reasons, the main aim of neurosurgeons in treating craniosynostosis is to relieve an increase in potential intracranial pressure on the neural tissues and prevent and or treat disorders of cognitive function. Thus, a widely used procedure in neurosurgery, barrel stave osteotomy, is applied to the majority of craniosynostosis cases. Hypothermia and hypovolemia are the most important causes of morbidity and mortality in surgical interventions of craniosynostosis (18). During surgery, heating blankets AIm: Barrel stave osteotomy is a widely used procedure in neurosurgery for the majority of craniosynostosis patients. Both in the intraoperative and postoperative periods, there is inevitable leakage type bleeding from the bones undergoing osteotomy. A number of studies have been performed in order to prevent this complication but a concise procedure is still lacking. mATERIAl and mEThODS: Synostectomy and parietotemporal barrel stave osteotomy were applied to 143 patients who were operated on with a diagnosis of craniosynostosis between the years 2005-2013. At the beginning to osteotomy, 5 ml/kg erythrocyte suspension (ES) was given for probable blood loss. Whole blood count was performed at the postoperative 1 st and 6 th hours and cases with hemoglobin levels below 10 or with hematocrit levels which had decreased more than 5% between the 1 st and 6 th hours were administered erythrocyte transfusion. RESUlTS:Of the patients, 100 were boys and 43 were girls. Of these, 98 had metopic, 30 had sagittal, 9 had metopic+sagittal, 4 had unilateral, 2 had bilateral and 6 had coronal synostosis. All the cases were administered intraoperative erythrocyte suspension. The preoperative amount of administered mean erythrocyte was 8.61 ml/kg. In the postoperative period, 92 patients were administered erythrocyte suspension. The postoperative amount of administered mean erythrocyte suspension was 7.98 ml/kg. CONClUSION:For an operated infant with craniosynostosis who is operated on in the first year of life, undergoing osteotomy and inevitable bone-borne blood losses are very i...

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Predictors of Blood Loss in Fronto-Orbital Advancement and Remodeling

Cited by 87 publications

References 9 publications

Higher fibrinogen concentrations for reduction of transfusion requirements during major paediatric surgery: A prospective randomised controlled trial

Higher fibrinogen concentrations for reduction of transfusion requirements during major paediatric surgery: A prospective randomised controlled trial

Puzzling ENIGMA

The management of blood loss in non-syndromic craniosynostosis patients undergoing barrel stave osteotomy

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