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Article / Publication Details
Introduction: This prospective study of children undergoing major craniofacial surgery was undertaken to determine whether abnormal hemostasis occurred and to characterize any coagulopathy found. Methods: Coagulation tests, blood loss and blood product transfusions were recorded perioperatively. Packed red blood cells (PRBC) were transfused to maintain target hematocrit. Patients with blood loss >100 ml/kg (group A, n = 5) were compared to patients with blood loss <100 ml/kg (group B, n = 22) using Mann-Whitney U test (p < 0.05). Results: Twenty-seven children (age range 2.9–27.9 months) had median total blood loss of 64 ml/kg. At completion of surgery, median coagulation values differed significantly between groups for prothrombin time (A: 16.6 s; B: 13.8 s), partial thromboplastin time (A: 44 s; B: 29 s), thrombin time (A: 28 s; B: 23 s), thromboelastograph reaction time (A: 7 mm; B: 4 mm), prothrombin fragment F1.2 (A: 1.9 nmol/l; B: 3.3 nmol/l) and platelet count (A: 174 K/mm–3; B: 239 K/mm–3). Fibrinolysis was not associated with blood loss. Median units transfused were in group A 3 units and group B 1 unit (p = 0.001). All patients received PRBC transfusions but only group A patients received other blood products (fresh frozen plasma, platelets). Conclusion: Children transfused with PRBC during craniosynostosis repair can become coagulopathic from coagulation factor depletion when hemorrhage approaches 1.5 times estimated blood volume.
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- Tessier P: Osteotomies totales de la face: Syndrome de Crouzon, syndrome d’Apert, oxycephalies, scaphocephalies, turricephalies. Ann Chir Plast 1967;12:273–294.
- McCarthy JG, Glasberg SB, Cutting CB, Epstein FJ, Grayson BH, Ruff G, Thorne CH, Wisoff J, Zide BM: Twenty-year experience with early surgery for craniosynostosis. I. Isolated craniofacial synostosis – results and unsolved problems. Plast Reconstr Surg 1995;96:272–283.
- Keating RF: Craniosynostosis: Diagnosis and management in the new millennium. Pediatr Ann 1997;26:600–612.
- Williams JK, Ellenbogen RG, Gruss JS: State of the art in craniofacial surgery: Nonsyndromic craniosynostosis. Cleft Palate Craniofac J 1999;36:471–485.
- Marchac D, Renier D, Broumand S: Timing of treatment for craniosynostosis and facio-craniosynostosis: A 20-year experience. Br J Plast Surg 1994;47:211–222.
- McCarthy JG, Glasberg SB, Cutting CB, Epstein FJ, Grayson BH, Ruff G, Thorne CH, Wisoff J, Zide BM: Twenty-year experience with early surgery for craniosynostosis. II. The craniofacial synostosis syndromes and pansynostosis: Results and unsolved problems. Plast Reconstr Surg 1995;96:284–295; discussion 296–298.
- Breugem CC, van RZBJ: Retrospective study of nonsyndromic craniosynostosis treated over a 10-year period. J Craniofac Surg 1999;10:140–143.
- Scholtes JL, Thauvoy C, Moulin D, Grimbomont BF: Craniofaciosynostosis: Anesthesia and perioperative management. Acta Anaesthesiol Belg 1985;36:176.
- Whitaker LA, Broennie AM, Kerr LP, Herlich A: Improvement in craniofacial reconstruction: Methods evolved in 235 consecutive patients. Plast Reconstr Surg 1980;65:561.
- Murray JE, Swanson LT, Strand RD, Hricko GM: Evaluation of craniofacial surgery in the treatment of facial deformities. Ann Surg 1975;182:240–265.
- Dahmani S, Orliaguet GA, Meyer PG, Blanot S, Renier D, Carli PA: Perioperative blood salvage during surgical correction of craniosynostosis in infants. Br J Anaesth 2000;85:550–555.
- Meyer P, Renier D, Arnaud E, Jarreau MM, Charron B, Buy E, Buisson C, Barrier G: Blood loss during repair of craniosynostosis. Br J Anaesth 1993;71:854–867.
- Eaton AC, Marsh JL, Pilgram TK: Transfusion requirements for craniosynostosis surgery in infants. Plast Reconstr Surg 1995;95:277–283.
- Kearney RA, Rosales JK, Howes WJ: Craniosynostosis: An assessment of blood loss and transfusion practices. Can J Anaesth 1989;36:473–477.
- Moylan S, Collee G, Mackersie A: Anaesthetic management in paediatric craniofacial surgery: A review of 126 cases. Paediatr Anaesth 1993;3:275–281.
- Imberti R, Locatelli D, Fanzio M, Bonfanti N, Preseglio I: Intra- and postoperative management of craniosynostosis. Can J Anaesth 1990;37:948–950.
- Buntain SG, Pabari M: Massive transfusion and hyperkalaemic cardiac arrest in craniofacial surgery in a child. Anaesth Intens Care 1999;27:530–533.
- Brown KA, Bissonnette B, McIntyre B: Hyperkalaemia during rapid blood transfusion and hypovolaemic cardiac arrest in children. Can J Anaesth 1990;37:747–754.
- Phillips RJ, Mulliken JB: Venous air embolism during a craniofacial procedure. Plast Reconst Surg 1988;82:155–159.
- Munro IR, Sabatier RE: An analysis of 12 years of craniomaxillofacial surgery in Toronto. Plast Reconst Surg 1985;76:29–36.
- Heiss MM: Risk of allogeneic transfusions. Br J Anaesth 1998;81:16–19.
- Palmer JD, Francis DA, Roath OS, Francis JL, Iannotti F: Hyperfibrinolysis during intracranial surgery: Effect of high-dose aprotinin. J Neurology Neurosurg Psych 1995;58:104–106.
- Kaufman HH, Hui KS, Mattson JC: Clinicopathological correlations of disseminated intravascular coagulation in patients with head injuries. Neurosurgery 1984;15:34–42.
- Fujii Y, Tanaka R, Takeuchi S, Koike T, Minakawa T, Sasaki O: Serial changes in hemostatis after intracranial surgery. Neurosurgery 1994;35:26–33.
- Cote CJ, Lui LMP, Szyfelbein SK, Goudsouzian NG, Daniels AL: Changes in serial platelet counts following massive blood transfusion in pediatric patients. Anesthesiology 1985;62:197–201.
- Murray DJ, Olson J, Strauss R, Tinker JH: Coagulation changes during packed red cell replacement of major blood loss. Anesthesiology 1988;69:839–845.
- Murray DJ, Pennell BJ, Weinstein SL, Olson JD: Packed red cells in acute blood loss: Dilutional coagulopathy as a cause of surgical bleeding. Anesth Analg 1995;80:336–342.
- Williams GD, Bratton SL, Riley EC, Ramamoorthy C: Coagulation tests during cardiopulmonary bypass correlate with blood loss in children undergoing cardiac surgery. J Cardiothorac Vasc Anesth 1999;13:398–404.
- Faberowski LW, Black S, Mickle JP: Blood loss and transfusion practice in the perioperative management of craniosynostosis repair. J Neurosurg Anesthesiol 1999;11:167–172.
- Kang JK, Lee SW, Baik MW, Son BC, Hong YK, Jung CK, Ryu KH: Perioperative specific management of blood volume loss in craniosynostosis surgery. Childs Nerv Syst 1998;14:297–301.
- Whitaker LA, Munro IR, Salyer KE, et al: Combined report of problems and complications in 793 craniofacial operations. Plast Reconstr Surg 1979;64:198.
- Dsida RM, Coté CJ: Hemorrhage in pediatric patients. Spiess BD, Counts RB, Gould SA (eds): Perioperative Transfusion Medicine. Baltimore, Williams & Wilkins, 1998, pp 537–552.
- Miller RD, Robbins JO, Tong MJ, Barton SL: Coagulation defects associated with massive blood transfusions. Ann Surg 1971;174:794–801.
- Counts RB, Haisch C, Simon TL, Maxwell NG, Heimbach DM, Carrico CJ: Hemostasis in massively transfused trauma patients. Ann Surg 1979;190:91–99.
- Ciavarella D, Reed RL, Counts RB, Baron L, Pavlin E, Heimbach DM, Carrico CJ: Clotting factor levels and the risk of diffuse microvascular bleeding in the massively transfused patient. Br J Haematol 1987;67:365–368.
- Andrew M, Paes B, Johnston M: Development of the hemostatic system in the neonate and young infant. Am J Pediatr Hematol-Oncol 1990;12:95–104.
- Miller RD: Complications of massive blood transfusions. Anesthesiology 1973;39:82–94.
- Miller RD: Coagulation and packed red blood cell transfusions. Anesth Analg 1995;80:215–216.
- Zlokovic BV, Wang L, Sun N, Haffke S, Verrall S, Seeds NW, Fisher MJ, Schreiber SS: Expression of tissue plasminogen activator in cerebral capillaries: Possible fibrinolytic function of the blood-brain barrier. Neurosurgery 1995;37:955–961.
- Francis RBJ: Clinical disorders of fibrinolysis: A critical review. Blut 1989;59:1–14.
- Mallett SV, Cox DJ: Thromboelastography. Br J Anaesth 1992;69:307–313.
- Williams GD, Bratton SL, Nielsen NJ, Ramamoorthy C: Fibrinolysis in pediatric patients undergoing cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1998;12:633–638.
- Bronza JP: Cellular regulation of tissue factor. Blood Coagul Fibrinolysis 1990;1:415–426.