Metabolic changes and factors influencing base deficit in infants undergoing craniosynostosis surgery: a retrospective study
Achmet Ali1, Burcu Basarn1, Gamze Tanırgan1, Aydın Aydoseli2, Altay Sencer2, Ibrahim Özkan Akıncı1
1Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesiology, Istanbul,Turkey
2Istanbul University, Istanbul Faculty of Medicine, Department of Neurosurgery, Istanbul, Turkey
BACKGROUND: Craniosynostosis is a disorder related to premature closure of cranial skull sutures. In present study, we evaluated severity risk factors and duration of metabolic disturbances in infants, undergoing cranyosynostosis surgery and its effect on postoperative morbidity. METHODS: A retrospective analysis was performed of 36 infants who underwent craniosynostosis surgery. We analysed the following: demographics, duration of surgery, intraoperative blood loss, RBC, FFP and fluids transfused, urine output, hemodynamic parameters, electrolyte values and base deficit values. Lowest BD value during the operation was calculated. Time periods required for BD values to be back at normal range for each patient were determined postoperatively (Period I: 0-6 hours, Period II: 6-12 hours, Period III: 12 hours and longer). In addition, we recorded: postoperative length of stay in the intensive care unit and hospital, postoperative blood loss and early complications. RESULTS: Metabolic acidosis were determined at 8 (25 %) patients intraoperatively. Lowest average BD value measured during the operation was -8.4 ± 2.6 mmol/L (Figure 1). We used multiple regression analyses revealed that lower BD values was associated with lower patient weight, longer duration of hypotension and greater intraoperative blood products transfusion (Figure 2). We were detected amount of intraoperative blood loss and blood product transfusion were less in Period I patients. We also founded that intraoperative hypotensive episode longer in Period III patients (Figure 3). Negative correlation was detected between lowest intraoperative BD value with duration of ICU (p=0.004, r = -0.466) and duration of hospital stay (p<0.001, r = -0.764). CONCLUSIONS: Metabolic acidosis is often seen and frequently continues until postoperative 12th hour in infants undergoing craniosynostosis surgery. Because of that metabolic follow-up is important at least as hemodynamic follow-up in these patients. Hipotension episodes, lower patients weight and blood product transfusion are risk factors for BD occurrence.
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