Anesthesiology pp 341-348 | Cite as

Anesthesia for Pediatric Plastic and Craniofacial Surgery

  • Shelley Joseph George
  • Michael Stuart GreenEmail author


The anesthetic management of children undergoing plastic and craniofacial surgeries poses significant and unique concerns for which the anesthesiologist must be prepared. Craniofacial surgery includes the correction of the skull, orbits and face. Repair of craniosynostosis requires an especially thoughtful approach that involves a multidisciplinary team. Although surgical practices have improved over time, the procedures used to correct this abnormality and its sequelae are still associated with significant morbidity and will be much of the focus of this chapter. The chapter will include a brief overview of common plastic surgery procedures and craniosynostosis management.


Craniosynostosis Airway management Syndactyly Hypertelorism Midface hypoplasia 


  1. 1.
    Karapurkar SA, Garasia MB, Deval DB. Anaesthesia and craniofacial surgery. J Postgrad Med. 1994;40:3–6.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Laberge LC. Local anesthesia for otoplasty in children. Clin Plast Surg. 2013;40(4):671–86.CrossRefPubMedGoogle Scholar
  3. 3.
    Engelhardt T, Crawford MW, Lerman J. Plastic and reconstructive surgery. In: Coté CJ, Lerman J, David Todres I, editors. A practice of anesthesia in infants and children. Philadelphia: Saunders Elsevier; 2009. p. 701–13.CrossRefGoogle Scholar
  4. 4.
    Sharma RK. Hypertelorism. Indian J Plast Surg. 2014;47(3):284–92. Scholar
  5. 5.
    Perkins JA, Sie KC, Milczuk H, Richardson MA. Airway management in children with craniofacial anomalies. Cleft Palate Craniofac J. 1997;34(2):135–40.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Raj D, Luginbuehl I. Managing the difficult airway in the syndromic child. Contin Educ Anaesth Crit Care Pain. 2015;15(1):7–13. Scholar
  7. 7.
    Kellman RM, Losquadro WD. Comprehensive airway management of patients with maxillofacial trauma. Craniomaxillofac Trauma Reconstr. 2008;1(1):39–47. Scholar
  8. 8.
    Barak M, Yoav L, Abu el-Naaj I. Hypotensive anesthesia versus normotensive anesthesia during major maxillofacial surgery: a review of the literature. Sci World J. 2015;2015:480728. Scholar
  9. 9.
    Sinkueakunkit A, Chowchuen B, Kantanabat C, Sriraj W, Wongswadiwat M, Bunsangjaroen P, Chantawong S, Wittayapairoj A. Outcome of anesthetic management for children with craniofacial deformities. Pediatr Int. 2013;55:360–5. Scholar
  10. 10.
    Thomas K, Hughes C, Johnson D, Das S. Anesthesia for surgery related to craniosynostosis: a review. Part 1. Paediatr Anesth. 2012;22(11):1022–41.CrossRefGoogle Scholar
  11. 11.
    Johnson D, Wilkie AOM. Craniosynostosis. Eur J Hum Genet. 2011;19(4):369–76. Scholar
  12. 12.
    Schindler E, Martini M, Messin-Junger M. Anesthesia for plastic and craniofacial surgery. In: Gregory GA, Andropoulos DB, editors. Pediatric anesthesia. Hoboken: Blackwell Publishing Ltd; 2012. p. 810–44.Google Scholar
  13. 13.
    Bir SC, Ambekar S, Notarianni C, Nanda A. Odilon Marc Lannelongue (1840-1911) and strip craniectomy for craniosynostosis. Neurosurg Focus. 2014;36(4):E16.CrossRefPubMedGoogle Scholar
  14. 14.
    Stricker PA, Fiadjoe JE. Anesthesia for craniofacial surgery in infancy. Anesthesiol Clin. 2013;32:215–35.CrossRefPubMedGoogle Scholar
  15. 15.
    Proctor MR. Endoscopic craniosynostosis repair. Transl Pediatr. 2014;3(3):247–58. Scholar
  16. 16.
    Rodgers W, Glass GE, Schievano S, Borghi A, Rodriguez-Florez N, Tahim A, Angullia F, Breakey W, Knoops P, Tenhagen M, O’Hara J, Ponniah A, James G, Dunaway DJ, Jeelani N. Spring assisted cranioplasty for the correction of non-syndromic scaphocephaly: a quantitative analysis of 100 consecutive cases. Plast Reconstr Surg. 2017;140(1):125–34.CrossRefPubMedGoogle Scholar
  17. 17.
    Jimenez DF, Barone CM. Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg. 1998;88(1):77–81.CrossRefPubMedGoogle Scholar
  18. 18.
    Chen EH, Gilardino MS, Whitaker LA, Bartlett SP. Evaluation of the safety of posterior cranial vault reconstruction. Plast Reconstr Surg. 2009;123(3):995–1001.CrossRefPubMedGoogle Scholar
  19. 19.
    Mendonca D, Gejje S, Kaladagi N. Fronto-orbital advancement: revisited. J Cleft Lip Palate Craniofac Anomal. 2015;2:20–6.CrossRefGoogle Scholar
  20. 20.
    Fiadjoe J, Stricker P. Pediatric difficult airway management: current devices and techniques. Anesthesiol Clin. 2009;27(2):185–95. Scholar
  21. 21.
    Francel P, Bell A, Jane J. Operative positioning for patients undergoing repair of craniosynostosis. Neurosurgery. 1994;35:304–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Faberowski L, Black S, Mickle J. Incidence of venous air embolism during craniectomy for craniosynostosis repair. Anesthesiology. 2000;92:20–3.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Stricker P, Shaw T, Desouza DE. Blood loss, replacement and associated morbidity in infants and children undergoing craniofacial surgery. Pediatr Anesth. 2010;20:150–9.CrossRefGoogle Scholar
  24. 24.
    Hughes C, Thomas K, Johnson D, Das S. Anesthesia for surgery related to craniosynostosis: a review. Part 2. Pediatr Anesth. 2012;23:22–7.CrossRefGoogle Scholar
  25. 25.
    Gurler T, Celik N, Total S. Prophylactic use of ondansetron for emesis after craniofacial operations in children. J Craniofac Surg. 1999;10:45–8.CrossRefPubMedGoogle Scholar
  26. 26.
    The Association of Paediatric Anaesthetists of Great Britain and Ireland. Guidelines on the prevention of post operative vominting in children; 2009.Google Scholar
  27. 27.
    Hasan R, Nikolis A, Dutta S. Clinical outcome of perioperative airway and ventilatory management in children undergoing craniofacial surgery. J Craniofac Surg. 2004;15:655–61.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Perioperative MedicineDrexel University College of MedicinePhiladelphiaUSA

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