Question

A 12-month-old, 7.0 kg infant with Apert syndrome, bilateral coronal and lambdoidal craniosynostosis is scheduled for a total calvarial vault reconstruction.
Discuss the blood loss management strategy for this patient.

Hint:

Early identification of blood loss and timely interventions, including blood transfusion, are crucial in managing blood loss in infants undergoing cranial surgery.

Answer 1

Blood loss is a significant concern during the total calvarial vault reconstruction in an infant with Apert syndrome and craniosynostosis. Careful planning and management are crucial to minimize complications.
Step 1: Preoperative Optimization:
1. Preoperative Hemoglobin Assessment: Check hemoglobin levels to assess the patient’s baseline status and determine if blood transfusion is required before surgery.
2. Blood Type and Crossmatch: Ensure availability of crossmatched blood or blood products, including packed red blood cells (PRBCs) and platelets, to address potential blood loss.
Step 2: Intraoperative Blood Loss Control:
1. Minimizing Blood Loss: Techniques such as controlled hypotension and hemostatic agents should be employed to minimize intraoperative bleeding.
2. Surgical Techniques: Employ meticulous surgical techniques to reduce unnecessary bleeding. Use of electrocautery or lasers may help in controlling bleeding during the procedure.
Step 3: Monitoring and Management:
1. Blood Loss Monitoring: Continuous monitoring of blood loss throughout the surgery is critical. Blood loss should be measured and recorded regularly.
2. Fluid and Electrolyte Management: Maintain the patient’s fluid balance to prevent hypovolemia. Crystalloid solutions, colloids, and blood products should be given as needed based on intraoperative blood loss.
Step 4: Postoperative Blood Loss Management:
1. Transfusion Protocol: Postoperative blood loss should be managed with appropriate transfusion of PRBCs and platelets to maintain hemodynamic stability and oxygen delivery.
2. Monitoring for Bleeding Complications: Postoperative drainage systems may be required to monitor ongoing bleeding, especially in the early postoperative period.
Step 5: Considerations in Infants:
1. Infant-Specific Concerns: In infants, the total blood volume is smaller, and blood loss can have a more profound effect. Careful attention to blood volume replacement and continuous monitoring is required.