Anesthesia and Postoperative Outcome in Pediatric Cranial Surgery: A Retrospective Single Center Study

Year 2022, Volume: 4 Issue: 2, 61 - 66, 01.07.2022

Naime Yalçın , Necmiye Ay Barış Sandal , Abdurrahim Derbent , Ziya Salihoğlu

https://doi.org/10.38175/phnx.1064132

Abstract

Background: Perioperative patient monitoring and follow-up is very important to minimize morbidity and mortality in pediatric neurosurgical interventions.
In this study, it was aimed to evaluate the perioperative anesthesia management by examining the findings of the pediatric patients who underwent cranial surgery along with to examine the effects of hemorrhagic surgical procedures, which play an active role in morbidity, both intraoperatively and postoperatively, including hospitalization in intensive care unit.
Methods: Follow-up files of 303 pediatric patients between the ages of 0-18, who were taken to cranial operation, between 2015-2018 years evaluated as retrospectively.
Results: A total of 303 children 199 (65.7%) ≤1 year old, 104 (34.3%) >1 year old who underwent pediatric neurosurgery were included in our study. It was determined that the most frequently performed operation was shunting due to hydrocephalus and craniosynostosis. In subanalysis, in craniosynostosis operations performed frequently in infants aged ≤1, it was observed that bleeding amount was as much as subdural and epidural hematoma operations performed in children >1 year old (181ml and 196 ml, p =0.444, respectively). There was no difference between groups in intensive care unit admission.
Conclusıons: We think that in pediatric neurosurgery patients' perioperative anesthesia management, it is important to closely monitor the vital signs of patients, to record complications and blood transfusions in detail. We believe that due to the more aggressive duration of hypotensive processes, more attention should be paid to morbidity and mortality, especially in cases of craniosynostosis.

Keywords

craniosynostosis, hydrocephalus, neurosurgery, pediatric, perioperative anesthesia management.

Pediatrik Kraniyal Cerrahide Anestezi ve Postoperatif Sonuçların Değerlendirilmesi: Retrospektif Tek Merkezli Çalışma

Abstract

Amaç: Pediyatrik nöroşirurjik cerrahi girişimlerde morbidite ve mortaliteyi en aza indirgemek için perioperatif hasta monitörizasyonu oldukça önemlidir. Bu çalışmada, kraniyal cerrahi uygulanan çocuk hastaların verileri incelenerek perioperatif anestezi yönetiminin değerlendirilmesi beraberinde morbiditede etkin rol oynayan hemorajik cerrahi prosedürlerin hem intraoperatif hem de yoğun bakım ünitesinde yatış sürecini de içeren postoperatif dönemdeki etkilerinin incelenmesi amaçlandı.
Gereç ve Yöntem: 2015-2018 yılları arasında kraniyal cerrahi nedeni ile operasyona alınmış 0-18 yaş arası, toplam 303 çocuk hastanın verileri retrospektif olarak değerlendirildi.
Bulgular: Çalışmamıza, pediatrik kraniyal cerrahi geçirmiş 199'u (%65,7) ≤1 yaş, 104'ü (%34,3) >1 yaşında olmak üzere toplam 303 çocuk dahil edildi. En sık hidrosefali nedeniyle şant ve kraniyosinostoz operasyonlarının olduğu belirlendi. Alt analizde ≤1 yaş bebeklerde sık uygulanan kraniyosinostoz ameliyatlarında kanama miktarının >1 yaş çocuklarda yapılan subdural ve epidural hematom ameliyatlarında ki kadar fazla olduğu görüldü (sırasıyla 181ml ve 196ml, p=0,444). Yoğun bakıma yatışta gruplar arasında fark yoktu.
Sonuç: Pediatrik beyin cerrahisi hastalarının perioperatif anestezi yönetiminde hastaların vital bulgularının yakından izlenmesi, komplikasyonların ve kan transfüzyonlarının detaylı olarak kayıt altına alınmasının önemli olduğunu düşünüyoruz. Hipotansif süreçlerin daha agresif seyir göstermesi nedeniyle, özellikle kraniyosinostoz vakalarında morbidite ve mortalitenin önlenmesi açısından daha fazla dikkat edilmesi gerektiğine inanıyoruz.

Keywords

hidrosefali, kraniyal cerrahi, kraniyosinostozis, pediatrik anestezi, perioperatif anestezi yönetimi

References

• Soriano SG., Eldredge EA., Rockoff MA. Pediatric neuroanesthesia. Anesthesiology Clin N Am. 2002;20(2):389-404.
• McClain CD and Soriano SG. Anesthesia for intracranial surgery in infants and children. Curr Opin Anesthesiol. 2014;27:465–469.
• Kalita N, Goswami A, Goswami P. Making Pediatric Neuroanesthesia Safer.J Pediatr Neurosci. 2017;12(4):305–312.
• Koh JL, Gries H. Perioperative management of pediatric patients with craniosynostosis. Anesthesiol Clin. 2007;25(3):465-481.
• Ahmadvand S, Dayyani M, Etemadrezaie H, Ghorbanpour A, Zarei R, Shahriyari A et al. Rate and risk factors of early ventriculoperitoneal shunt revision: A five- year retrospective analysis of a referral center. World Neurosurgery. 2020;134:e505-e511.
• Tervonen J, Leinonen V, Jääskeläinen JE, Koponen S., Huttunen TJ. Rate and risk factors of shunt revision in pediatric hydrocephalus patients a population-based study. World Neurosurgery. 2017;101:615-622.
• Thomas K, Hughes C, Johnson D, Das S. Anesthesia for surgery related to craniosynostosis: a review. Part 1. Paediatr Anaesth. 2012;22(11):1033-41.
• Arts S, Delye H, Van Lindert EJ, Blok L, Borstlap W, Driessen J. Evaluation of anesthesia in endoscopic strip craniectomy: A review of 121 patients. Pediatric Anesthesia. 2018;28(7):647-653.
• Thurman DJ. The Epidemiology of Traumatic Brain Injury in Children and Youths: A Review of Research Since 1990. J Child Neurol. 2016;31(1):20-27. doi: 10.1177/0883073814544363
• Huh JW, Raghupathi R. Therapeutic strategies to target acute and long-term sequelae of pediatric traumatic brain injury. Neuropharmacology. 2019;145(Pt B):153-159. doi:10.1016/j.neuropharm.2018.06.025
• Stricker PA, Goobie SM, Cladis FP, Haberkern CM, Meier PM, Reddy SK, et al. Perioperative Outcomes and Management in Pediatric Complex Cranial Vault Reconstruction: A Multicenter Study from the Pediatric Craniofacial Collaborative Group. Anesthesiology. 2017;126(2):276-287.
• Owojuyigbe AM, Komolafe EO, Adenekan AT, Dada MA, Onyia CU, Ogunbameru IO, et al. Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice. Afr J Paediatr Surg. 2016;13(2):76-81.
• Rath GP, Dash HH. Anaesthesia for neurosurgical procedures in paediatric patients. Indian J Anaesth. 2012;56(5):502-510.
• Drake JM, Riva-Cambrin J, Jea A, Auguste K., Tamber M., Pasculli ML. Prospective surveillance of complications in a pediatric neurosurgery unit. J Neurosurg Pediatr. 2010;5(6):544-548.
• De Francisci G, Papasidero AE, Spinazzola G, Galante D, Caruselli M, Pedrotti D, et al. Update on complications in pediatric anesthesia. Pediatr Rep. 2013;5(1):e2.
• Stricker PA, Fiadjoe JE. Anesthesia for craniofacial surgery in infancy. Anesthesiol Clin. 2014;32(1):215-235.
• Abbas Q, Shabbir A, Siddiqui NR, Kumar R., Haque A. Burden of neurological illnesses in a pediatric intensive care unit of developing country. Pakistan J Med Sci. 2014;30(6):1223-1227.
• Grinspan ZM, Eldar YC, Gopher D, Gottlieb A, Lammfromm R, Mangat HS, et al. Guiding Principles for a Pediatric Neurology ICU (neuroPICU) Bedside Multimodal Monitor: Findings from an International Working Group. Appl Clin Inform. 2016;7(2):380-398.
• Howe PW, Cooper MG. Blood loss and replacement for paediatric cranioplasty in Australia - a prospective national audit. Anaesth Intensive Care. 2012;40(1):107-113.
• Meyer P, Renier D, Arnaud E, Jarreau MM, Charron B, Buy E, et al. Blood loss during repair of craniosynostosis. Br J Anaesth. 1993;71(6):854-857.
• Kearney RA, Rosales JK, Howes WJ. Craniosynostosis: an assessment of blood loss and transfusion practices. Can J Anaesth. 1989;36(4):473-477.
• Stricker PA, Shaw TL, Desouza DG, Hernandez SV, Bartlett SP, Friedman DF, et al. Blood loss, replacement, and associated morbidity in infants and children undergoing craniofacial surgery. Pediatric Anesthesia. 2010;20:150-159.
• Melin AA, Moffitt J, Hopkins DC, Shah MN, Fletcher SA, Sandberg DI, et al. Is Less Actually More? An Evaluation of Surgical Outcomes Between Endoscopic Suturectomy and Open Cranial Vault Remodeling for Craniosynostosis. J Craniofac Surg. 2020;31: 924–926.
• Bonfield CM, Basem J, Cochrane D, Singhal A, Steinbok P. Examining the need for routine intensive care admission after surgical repair of nonsyndromic craniosynostosis: a preliminary analysis. J Neurosurg Pediatr. 2018;22(6):616-619.
• Seruya M, Sauerhammer TM, Basci D, Rogers GF, Boyajian MJ, Myseros JS, et al: Analysis of routine intensive care unit admission following fronto-orbital advancement for craniosynostosis. Plast Reconstr Surg. 2013;131:582e–588e.
• Goobie SM, Zurakowski D, Proctor MR, Meara JG, Meier PM, Young VJ, et al. Predictors of Clinically Significant Postoperative Events after Open Craniosynostosis Surgery. Anesthesiology. 2015;122:1021-32.
• Miller P, Mack CD, Sammer M, Rozet I, Lee LA, Muangman S, et al. The Incidence and Risk Factors for Hypotension During Emergent Decompressive Craniotomy in Children with Traumatic Brain Injury. Anesthesia and Analgesia. 2006;103(4):869-875.
• Khan SA, Shallwani H, Shamim MS, Murtaza G, Enam SA, Qureshi RO, et al. Predictors of poor outcome of decompressive craniectomy in pediatric patients with severe traumatic brain injury: a retrospective single center study from Pakistan.Childs Nerv Syst. 2014;30(2):277-81.
• Fenton SJ, Campbell SJ, Stevens AM, Zhang C, Presson AP, Lee JH. Preventable pediatric intensive care unit admissions over a 13-year period at a level 1 pediatric trauma center. Journal of Pediatric Surgery. 2016;51:1688–1692.