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Craniosynostosis: an assessment of blood loss and transfusion practices

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Abstract

Assessment and accurate replacement of blood loss during primary craniosynostosis repair is difficult due to patient size and surgical technique. Eighty-five charts of all patients undergoing primary craniosynostosis repair over a 15-year period were reviewed to determine blood loss and to assess blood transfusion practices both intraoperatively and postoperatively. Blood loss was calculated on the basis of estimated red cell mass (ERCM). Blood transfusion management was considered appropriate if the postoperative or posttransfusion ERCM was within 15 per cent of the preoperative value. Isolated sagittal craniectomy was the most common operation performed (60 per cent). Mean blood loss for sagittal craniectomies was 24 per cent of estimated blood volume (EBV) or approximately 20 ml · kg−1 and for metopic craniectomies 42 per cent of EBV (P < 0.05). Intraoperatively, 70 per cent of all patients were appropriately managed with respect to blood transfusion. Postoperatively only 29 per cent of patients receiving transfusions were transfused appropriately. At our institution, intraoperative blood transfusion practices are appropriate, but postoperative transfusions are frequently unnecessary.

Résumé

La technique chirurgicale et la taille des patients rendent difficiles l’ evaluation et le remplacement des pertes sanguines lors d’une primo-correction de craniosynostose. Nous avons revise 85 dossiers s’ échelonnant sur 15 ans, afin d’ évaluer les pertes sanguines et leur remplacement par transfusion de sang pendant et après ce type d’intervention. Les pertes étaient calculées en fonction d’un estimé de la masse des globules rouges (MGRE) et pour qualifier d’adéquat le remplacement, la MGRE post-opératoire ou post-transfusion devait être égale à la valeur pré-opératoire à 15 pour cent près. Pour les craniectomies sagittales isolées, pratiquées dans 60 pour cent des cas, les pertes équivalaient en moyenne à 24 pour cent du volume sanguin estimé (VSE) soit approximativement 20 ml · kg−1, alors que 42 pour cent du VSE était perdu avec les craniectomies métopiques (P < 0.05). Pendant la période per-opératoire, 70 pour cent des patients éetaient transfusés de façon adéquate, mais seulement 29 pour cent l’ étaient en période post-opératoire. Ainsi, dans notre milieu, la pratique de transfusion intra-opératoire est satisfaisante mais plusieurs transfusions sanguines post-operatoires sont injustifiées.

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Correspondence to Ramona A. Kearney.

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Kearney, R.A., Rosales, J.K. & Howes, W.J. Craniosynostosis: an assessment of blood loss and transfusion practices. Can J Anaesth 36, 473–477 (1989). https://doi.org/10.1007/BF03005352

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Key words

  • anaesthesia: paediatric
  • surgery: paediatric, neurological, craniosynostosis
  • transfusion: stored blood