Related Experiment Videos
Craniofaciosynostosis: anesthetic and perioperative management. Report of 71 operations
Insights
This study shows that surgical correction of faciocranial dysmorphisms in infants is safe, with no long-term issues or deaths. A multidisciplinary approach in well-equipped hospitals is key for successful outcomes.
Area of Science:
- Pediatric Surgery
- Craniofacial Surgery
- Anesthesiology
Background:
- Faciocranial dysmorphisms require complex surgical correction for functional, esthetic, and psychological improvement.
- Early surgical intervention is often necessary for optimal outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of surgical correction for faciocranial dysmorphisms in infants.
- To review peri- and post-operative complications and outcomes over a 9-year period.
Main Methods:
- Retrospective review of 71 surgical operations performed over 9 years.
- Detailed anesthetic management including osmotic diuresis, hyperventilation, induced hypotension, and semi-sitting position.
- Comprehensive hemodynamic monitoring with arterial lines and central venous catheters.
Main Results:
- Operations performed on 71 infants, with 48% under 6 months old.
- Average surgical time of 210 minutes; average blood loss of 62% of estimated blood volume.
- Most common complications included bradycardia (15 cases), venous sinus opening (2 cases), glottic edema (5 cases), and CSF leak (2 cases); no long-term sequelae, infections, or perioperative mortality.
Conclusions:
- Infants with craniofaciosynostosis can undergo surgical correction with low perioperative risk.
- Successful prevention of complications and functional results depend on a multidisciplinary approach and well-equipped facilities.
Abstract:
Faciocranial dysmorphisms are at the present time corrected during very complex procedures aiming at functional, esthetic and psychological improvement. The authors present their 9 years experience of 71 operations. The age at which those operations are performed is between 6 and 12 months for 14 patients (20%) and under 6 months for 34 patients (48%), the youngest patient being 6 weeks old. Per- and post-operative problems are reviewed. Mean surgical time is 210 minutes. The anesthetic approach aims at reducing the size of the brain by the use of osmotic diuresis, slight hyperventilation, moderate induced hypotension and semi-sitting position. The hemodynamic monitoring includes for all patients an arterial line and a central venous catheter. Blood loss can be large and sometimes sudden; it amounts in average to 62% of patient's estimated blood volume (12 to 200%). The most frequently encountered complications are cardiac dysrhythmias (mainly bradycardia 15 cases), accidental venous sinus opening (2 cases), post-extubation glottic edema (5 cases) and postoperative cerebrospinal leak (2 cases). No long-term sequelae persist from those incidents. There is neither infection, nor perioperative mortality. From those results, the authors consider that infants with craniofaciosynostosis can be operated upon and their dysmorphy corrected with a low perioperative risk. However successful prevention of complications and functional result depend essentially on a multidisciplinary approach, in well-equipped hospitals.