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Published on: January 28, 2020
Perioperative management of children undergoing craniofacial reconstruction surgery: a practice survey
Paul A Stricker1, Franklyn P Cladis, John E Fiadjoe
1Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. strickerp@email.chop.edu
Insights
Practices for managing children undergoing craniofacial surgery vary significantly. Further research is needed to establish optimal strategies for perioperative care, including monitoring and transfusion protocols.
Area of Science:
- Pediatric surgery
- Craniofacial reconstruction
- Perioperative care
Background:
- Craniofacial reconstruction in children presents management challenges due to significant blood loss and associated morbidity.
- Various techniques exist to optimize care, but their current utilization is unclear.
Purpose of the Study:
- To assess current management practices for pediatric craniofacial surgery.
- To identify significant practice variations.
- To guide future research in this field.
Main Methods:
- A web-based survey was distributed to 102 institutions.
- One representative per institution completed the survey to ensure unbiased results.
- The survey covered management of infants undergoing strip craniectomies and major craniofacial reconstruction.
Main Results:
- 48 out of 102 institutions completed the survey.
- The survey revealed substantial differences in managing infants and children undergoing craniofacial procedures.
Conclusions:
- Significant variability in managing pediatric craniofacial surgery necessitates further investigation into optimal strategies.
- Clinical trials on central venous pressure and hemodynamic monitoring are recommended for evidence-based decision-making.
- Developing institutional transfusion thresholds is encouraged due to proven efficacy and safety.
Objective/Aims:
To assess current practices in the management of children undergoing craniofacial surgery and identify areas of significant practice variability with the intent to direct future research.
Background:
The perioperative management of infants and children undergoing craniofacial reconstruction surgery can be challenging because of the routine occurrence of significant blood loss with associated morbidity. A variety of techniques have been described to improve the care for these children. It is presently unknown to what extent these practices are currently employed.
Methods:
A web-based survey was sent to representatives from 102 institutions. One individual per institution was surveyed to prevent larger institutions from being over-represented in the results.
Results:
Requests to complete the survey were sent to 102 institutions; 48 surveys were completed. The survey was composed of two parts: management of infants undergoing strip craniectomies, and management of children undergoing major craniofacial reconstruction.
Conclusions:
Significant variability exists in the management of children undergoing these procedures; further study is required to determine the optimal management strategies. Clinical trials assessing the utility of central venous pressure and other hemodynamic monitoring modalities would enable evidence-based decision-making for monitoring in these children. The development of institutional transfusion thresholds should be encouraged, as there exists a body of evidence supporting their efficacy and safety.
