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[Evaluation of transfusion strategies during craniosynostosis repairs]
E Frebet1, M P Preckel, N Poirier
1Département d'anesthésie-réanimation, centre hospitalier universitaire, Angers, France.
Insights
Transfusion practices in pediatric craniosynostosis surgery became more restrictive due to transfusion risks. This led to fewer children receiving blood transfusions, emphasizing careful blood loss management.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Hematology
Background:
- Craniosynostosis surgery in children can involve significant blood loss.
- Transfusion-associated risks necessitate careful evaluation of blood product administration.
Purpose of the Study:
- To assess changes in transfusion practices during pediatric craniosynostosis repair.
- To evaluate the impact of transfusion-associated risks on surgical management.
Main Methods:
- Retrospective analysis of 64 craniosynostosis repairs over 17 years.
- Comparison of two groups with differing transfusion trigger criteria (pre-1992 vs. post-1992).
- Statistical analysis using two-tailed Student's t-test to compare outcomes.
Main Results:
- The rate of non-transfused children increased significantly from 6% to 39% after 1992.
- Conversely, the rate of postoperative transfusions also rose from 3% to 39% in the later period.
- Mean preoperative and postoperative hemoglobin, estimated blood loss, and replaced blood volume were compared between groups.
Conclusions:
- Concerns regarding transfusion risks have driven the adoption of more restrictive transfusion protocols.
- Effective blood management in craniosynostosis surgery requires close collaboration between surgical and anesthesia teams.
- Establishing clear guidelines for acceptable blood loss is crucial for limiting unnecessary transfusions.
Objective:
To evaluate the changes in transfusion practices during craniosynostosis surgery in children, with consideration of the transfusion-associated risks.
Study Design:
Retrospective study.
Patients:
The study included 64 consecutive craniosynostosis repairs by the same neurosurgical and anaesthetic team, over a period of 17 years.
Methods:
The children were allocated into two groups. In group I (1980-1991), blood loss was compensated precisely from scalp incision on. In group II (1992-1996), transfusion was only started when blood loss crossed a calculated limit considered as acceptable. The mean criterion of judgment was the quantity of transfused blood in comparison with the theoretical blood volume. Mean preoperative and postoperative haemoglobin concentrations, estimated blood losses, volume of replaced blood and number of transfused patients were compared between the two groups with a two tailed Student's t test.
Results:
The rate of non transfused children increased from 6% before 1991 to 39% after 1992%; conservely the rate of postoperative transfusions increased from 3 to 39%.
Conclusion:
The risks of blood transfusion favoured the development of new of more restrictive transfusion practices, even in haemorrhagic surgery. To limit blood transfusion in craniosynostosis surgery, a harmonious cooperation between surgeons and anaesthetists is essential and blood replacement must be based on a definite determination of the acceptable blood losses.