Perioperative management of children undergoing craniofacial reconstruction surgery: a practice survey

Paediatr Anaesth. 2011 Oct;21(10):1026-35. doi: 10.1111/j.1460-9592.2011.03619.x. Epub 2011 May 20.

Abstract

Objective/aims: To assess current practices in the management of children undergoing craniofacial surgery and identify areas of significant practice variability with the intent to direct future research.

Background: The perioperative management of infants and children undergoing craniofacial reconstruction surgery can be challenging because of the routine occurrence of significant blood loss with associated morbidity. A variety of techniques have been described to improve the care for these children. It is presently unknown to what extent these practices are currently employed.

Methods: A web-based survey was sent to representatives from 102 institutions. One individual per institution was surveyed to prevent larger institutions from being over-represented in the results.

Results: Requests to complete the survey were sent to 102 institutions; 48 surveys were completed. The survey was composed of two parts: management of infants undergoing strip craniectomies, and management of children undergoing major craniofacial reconstruction.

Conclusions: Significant variability exists in the management of children undergoing these procedures; further study is required to determine the optimal management strategies. Clinical trials assessing the utility of central venous pressure and other hemodynamic monitoring modalities would enable evidence-based decision-making for monitoring in these children. The development of institutional transfusion thresholds should be encouraged, as there exists a body of evidence supporting their efficacy and safety.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antifibrinolytic Agents / therapeutic use
  • Blood Component Transfusion
  • Blood Loss, Surgical
  • Blood Transfusion, Autologous
  • Central Venous Pressure
  • Child
  • Craniofacial Abnormalities / surgery*
  • Craniotomy
  • Embolism, Air / prevention & control
  • Endoscopy
  • Erythropoietin / therapeutic use
  • Health Care Surveys
  • Humans
  • Monitoring, Intraoperative
  • Operative Blood Salvage
  • Perioperative Care / methods*
  • Reconstructive Surgical Procedures*

Substances

  • Antifibrinolytic Agents
  • Erythropoietin