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PEDIATRIC ANESTHESIA

Surgical Advancement Influences Perioperative Care: A Comparison of Two Surgical Techniques for Sagittal Craniosynostosis Repair

Departments of Anesthesiology, Neurosurgery, and Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Address correspondence to Douglas G. Ririe, MD, Department of Anesthesiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1009. Address e-mail to dririe{at}wfubmc.edu

Methods for surgical correction of sagittal craniosynostosis have progressed. The hypothesis is that advances in surgical interventions for craniosynostosis affect perioperative anesthetic care. We reviewed the records of eight children who underwent cranial vault reconstruction (CVR) and nine who underwent spring-mediated cranial expansion (SME) for sagittal craniosynostosis. We compared the data from the CVR procedure to data from the combined procedures for SME (insertion and removal of springs). Anesthesia times were similar between the CVR (4 h 24 min) and the combined SME (4 h 27 min) groups, whereas surgical times were different between the CVR (3 h 25 min) and combined SME groups (2 h 21 min) (P = 0.002). Length of stay was 4.1 days for the CVR group (confidence interval [CI], 3.8–4.4 days) versus 3.1 days (CI, 2.9–3.4 days) in the combined SME group (P = 0.0001). Blood loss was significantly less in the combined SME group at 48 mL (CI, 29–83 mL) compared with the CVR group at 291 mL (CI, 230–352 mL). All eight patients in the CVR group received blood with a mean of 1.4 U (range, 1–2 U). No SME patient received any blood products. The reduction in blood loss with this new surgical treatment is significant for the patient in reducing blood transfusion and for the anesthesiologist in reducing concerns of volume resuscitation.

IMPLICATIONS: This study compares the perioperative management of two different surgical procedures for the repair of sagittal craniosynostosis. Progress in surgical technique results in differences in perioperative care that directly impact anesthetic management.

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				D. G. Ririe, P. E. Lantz, S. S. Glazier, and L. C. Argenta Transfusion-Related Acute Lung Injury in an Infant During Craniofacial Surgery Anesth. Analg., October 1, 2005; 101(4): 1003 - 1006. [Abstract] [Full Text] [PDF]