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Anesthetic Management of Pediatric Craniofacial Surgery and Methods of Reducing Blood Loss

Ebru Biricik, Yasemin Güneş.

Abstract
One of the most common craniofacial congenital abnormalities requiring surgery is craniosynostosis where there is premature fusion of one or more cranial sutures. A thorough assessment of the airway is necessary to enable careful planning of the anesthetic technique for craniofacial surgery. Pediatric craniofacial reconstruction procedures, has been associated with significant morbidity including cardiac arrest, massive transfusion, coagulopathy, severe hypotension, air embolism, largely related to blood loss. Transfusion of homologous blood is associated with significant and well-known risks. Reported transfusion rates for pediatric patients undergoing surgical correction of synostotic calvarial sutures vary between 20 and 500% of estimated blood volume. Attempts at reducing exposure to allogeneic transfusions, using blood conservation techniques such as controlled hypotension and normovolemic hemodilution, have met with mixed results and are not always practical in small infants. In children undergoing surgical correction of craniosynostosis, pre-treated with erythropoietin, intraoperative tranexamic acid reduces transfusion requirement.

Key words: Craniosynostosis, blood loss, erythropoietin, Tranexamic Acid, otologous transfusion.



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