Anaesthetic management of craniosynostosis repair - A retrospective study

Comparison of Perioperative Anesthetic Concerns in Simple and Complex Craniosynostosis Cases: A Retrospective Study

Background We compared intraoperative and postoperative anesthetic parameters between simple (S-single suture) and complex (C-more than one suture) craniosynostosis cases.

Materials and Methods Data was collected from a retrospective review of anesthetic and postoperative records of patients who underwent craniosynostosis correction surgery between April 2014 and August 2019. Pearson’s chi-square and independent sample t-tests were used for analysis.

Results We analyzed data of 98 patients (S-simple craniosynostosis: 40 and C-complex craniosynostosis: 58). Statistically significant differences between simple and complex cases were seen only in the incidence of difficult airway, failed extubation, and requirement of postoperative ventilation. Massive blood loss (S: 23.21 mL/kg; C: 22.71 mL/kg) and difficult airway (S: 2.04%; C: 19.39%) were the most common intraoperative adverse events encountered. Metabolic abnormalities, hemodynamic instability, and hypothermia occurred in few patients. The most common postoperative issue was pyrexia (S: 15.31%; C: 17.35%). Anemia and coagulopathy needing transfusion of blood products and vitamin K injection were seen in a significant number of cases. Three nonsyndromic patients developed seizures.

Conclusion The incidence of difficult airway and failed extubation with postoperative ventilation is more frequent following surgery for complex craniosynostosis than simple craniosynostosis. Complications secondary to blood loss and airway issues were the primary cause of morbidity and mortality. A staged approach to surgical management resulted in decreased surgical blood loss among the children with complex craniosynostosis.