Perioperative Anaesthetic Management of Pediatric Patients in Craniosynostosis

ABSTRACT

Aim: In this study, we aimed to present the perioperative anaesthetic management in pediatric patients who underwent surgery for craniosynostosis which can progress with life-threatening complications.

Materials and Method: We retrospectively reviewed the file of all 26 craniosynostosis patients who were operated between January 2009-January 2021. The following were analyzed retrospectively: demographic data; anesthesia risks; duration of anesthesia and surgery; additional conditions of abnormality; airway and bleeding management; complications.

Results: Of the 26 patients included in the study, 16 had trigonocephaly, 4 scaphocephaly, 3 plagiocephaly, and 3 mixed types. Twenty (76.9%) of the patients were male, and 6 (23.1%) were female. Five out of the 26 patients (19.23%) had additional anomalies (1 Apert syndrome, 2 cardiac anomalies, and 2 hydrocephalus). The mean duration of surgery was 167.03 min, and duration of anesthesia was 179.92 min. CL scores were evaluated in direct laryngoscopy of the patients. CL I was found in 5 patients (19.2%), CL II in 13 patients (50.0%) and CL III in 8 patients (30.8%). Severe hypotension was observed in 5 patients (19.23%) in the intraoperative period. Noradrenaline at a dose of 0.03 mg/kg/min was administered to these patients with simultaneous blood and fluid infusion. A statistically significant difference was found between the preoperative and intraoperative hematocrit values of the patients whose mean preoperative hematocrit values were 35.99% and intraoperatively 26.85% (0.001).

Conclusions: We observed that pediatric patients with craniosynostosis had difficulty in airway management and risk of massive intraoperative bleeding. These patients require carefully planned anesthetic management.

Key words: Craniosynostosis, pediatric patients, anaesthetic management, bleeding management