Blood loss and transfusion practice in the perioperative management of craniosynostosis repair

During the past 5 years, the surgical repair for sagittal synostosis has be en modified to a more complex and involved procedure. This led to a retrosp ective evaluation of the current transfusion practice in a large series of craniosynostosis repairs. The charts of 76 patients (81 surgical procedures ) undergoing craniosynostosis repair from January 1990 to November 1996 wer e examined. The calculated volume of blood loss (BL) was determined for eac h surgical procedure and related to the estimated blood volume (EBV) and ac ceptable blood loss (ABL). The anesthesiologist's ability to estimate BL wa s compared with the calculated blood loss (CBL). In most surgical procedure s for craniosynostosis, especially in the complex sagittal repairs, CBL was underestimated and exceeded ABL. Packed red blood cell transfusion occurre d in 96.3% of the patients and was appropriate for most procedures based on ABL. Thus, transfusion for craniosynostosis repair is almost inevitable, a nd the preventive preparation of blood on the order of the mean estimated b lood loss (EBL)plus 2 SD is appropriate. With the increased complexity of s agittal repair and its performance in a younger population, the cosmetic be nefit of surgical repair has major implications for management of blood and fluids.