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Perioperative Hemostasis in Pediatric Surgery

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Perioperative Hemostasis

Abstract

The management of intraoperative bleeding in children is challenging and requires thoughtful diagnostics and therapy. A reliable and effective concept for bleeding therapy should be based on timely coagulation testing (e.g. ROTEM®), but this should be adapted to local conditions and resources. Ideally, an interdisciplinary operating procedure should be prepared and all pediatric anesthesiologists should be trained to use it. This procedure may include prophylactic administration of tranexamic acid for high risk procedures, provision of a cell salvage device, and a detailed bleeding history (for all patients). As there is no evidence-based data on universal coagulation therapy using transfusion of fresh frozen plasma, targeted administration of purified coagulation factors might offer a fast and safe alternative. For instance, the most common intraoperative hemostasis disorders are caused by dilutional coagulopathy, with an underlying fibrinogen and/or FXIII deficiency, both of which can be effectively treated with purified coagulation factors. More severe bleeding episodes may also affect platelet count and thrombin building capacity, whereas hyperfibrinolysis is a rare event during major pediatric surgery.

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  1. Department of Anesthesia, Zurich University Children’s Hospital, Steinwiesstrasse 75, Zurich, CH-8032, Switzerland

    Thorsten Haas MD

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  1. Thorsten Haas MD
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Correspondence to Thorsten Haas MD .

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  1. Department of Anesthesiology, University Hospital of Lausanne, Lausanne, Switzerland

    Carlo Enrique Marcucci

  2. Department of Anesthesiology, University Hospital of Lausanne, Lausanne, Switzerland

    Patrick Schoettker

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Haas, T. (2015). Perioperative Hemostasis in Pediatric Surgery. In: Marcucci, C., Schoettker, P. (eds) Perioperative Hemostasis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-55004-1_16

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