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Quantitative Assessment Protocol for Facial Soft Tissue Volumetric Changes with Stereophotogrammetry

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Metabolic changes during major craniofacial surgery.

Arnwald Y S Choi¹, Nargis S Ahmad, David A H de Beer

¹Department of Anaesthesia, Great Ormond Street NHS trust, London, UK. arnie@doctors.org.uk

Paediatric Anaesthesia

|August 19, 2010

Summary

This summary is machine-generated.

Children undergoing major craniofacial surgery can experience significant metabolic acidosis, with recovery taking several hours. Blood loss and replacement, not surgery duration, appear to influence the severity of this metabolic disturbance.

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Area of Science:

Pediatric Surgery
Anesthesiology
Critical Care Medicine

Background:

Major craniofacial surgery in children poses risks of substantial blood loss and metabolic acidosis.
Base deficit (BD) monitoring is standard for assessing perioperative metabolic disturbance.

Purpose of the Study:

To document the degree and duration of perioperative metabolic disturbance in pediatric craniofacial surgery.
To correlate metabolic changes with surgery length and intraoperative fluid administration.

Main Methods:

Prospective study of children undergoing elective major craniofacial surgery.
Serial measurement of arterial blood gas-derived base deficit (BD) at standardized intervals.
Multiple regression analysis using surgery duration and blood/colloid volume as covariates.

Main Results:

Maximum base deficit (BD) ranged from -3 to -20, with a median of -9.
The median time for BD to normalize was 9.25 hours.
The median duration of significant BD was 3.8 hours.

Conclusions:

Children undergoing major craniofacial surgery frequently develop perioperative metabolic acidosis.
The severity of metabolic acidosis correlates with intraoperative blood loss and replacement volume, not surgery duration.
Postoperative admission to a neurosurgical high-dependency unit for overnight monitoring is recommended due to unpredictable metabolic acidosis.