An approach to reducing blood loss during reconstructive operations on the bones of the skull in children with craniosynostosis
Authors: Pulkina O. N. , Ivanov V. P. , Parshin E. V. 
Published: July 2023

Background. Radical reconstructive operations on the bones of the skull in children with craniostenoses are always accompanied by significant intraoperative blood loss. The range of blood saving methods for children is narrower than for adults. Unfortunately, the incidence of post-transfusion reactions and complications remains high, and for infants who have undergone traumatic surgery, the occurrence of such a complication can be fatal. This dictates the need to search for new and effective methods of blood saving for children, which is especially important in the surgical treatment of various forms of craniosynostosis.

The objective was to evaluate the effectiveness of the developed approach to reducing blood loss during radical reconstructive operations on the bones of the skull in children. Study design: cohort, prospective study

Materials and methods. Design: a cohort, prospective study, which included 50 children diagnosed with craniosynostosis who underwent radical reconstructive surgery on the bones of the skull. To reduce blood loss, the developed approach was used, which included hypervolemic hemodilution, the introduction of an antifibrinolytics and infiltration of the skin flap with a local anesthetic before surgical incision. During the operation, the volume of blood loss, the level of hemoglobin, hematocrit, acid-base state were recorded at 3 stages of surgical treatment. The international normalized ratio, activated partial thromboplastin time, fibrinogen concentration were evaluated before surgical treatment and at the end of surgery. A comparative analysis of approaches to replacement of intraoperative blood loss before and after the introduction of the proposed method of blood saving was carried out.

Results. The level of blood loss in most cases corresponded to 1 and 2 degrees. Hemotransfusions were performed in 23 children (46%). Prior to the introduction of the proposed method of blood saving, intraoperative blood transfusion was performed in 100% of patients. Comparison of the coagulation system indicators before the operation and at the end of the 3rd stage of the operation showed statistically significant differences and corresponded to their active consumption. Evaluation of SO2, ctO2, P50 indicators at all stages of the operation showed no deviation from normal values

Conclusion. The average level of blood loss in the surgical treatment of craniosynostosis in children corresponds to 1–2 degrees. The level of consumption of blood clotting factors increases by the end of the main stage of surgical treatment, but does not reach the indicators at which there is a need to use freshly frozen plasma (NWF). A developed approach to the correction of blood loss in children with craniosynostosis, including: the use of hypervolemic hemodilution, the introduction of tranexamic acid, infiltration of the skin flap with a local anesthetic with epinephrine before surgical incision, infusion therapy in a restrictive mode after surgical incision allowed minimizing the use of blood preparations.