The Journal of craniofacial surgery
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Randomized Controlled Trial Comparative Study
Successful blood conservation during craniosynostotic correction with dual therapy using procrit and cell saver.
Craniosynostotic correction typically performed around infant physiologic nadir of hemoglobin (approximately 3-6 months of age) is associated with high transfusion rates of packed red blood cells and other blood products. As a blood conserving strategy, we studied the use of 1) recombinant human erythropoietin or Procrit (to optimize preoperative hematocrit) and 2) Cell Saver (to recycle the slow, constant ooze of blood during the prolonged case). ⋯ Our data showed that for elective craniosynostotic correction, successful blood conserving dual therapy with Procrit and Cell Saver might be used to decrease transfusion rates and the need for any blood products.
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Randomized Controlled Trial Clinical Trial
Hypotensive anesthesia and recovery of cognitive function in long-term craniofacial surgery.
The aim of our study was to compare three different anesthesiological techniques with regard to hemodynamics, recovery, and postoperative morbidity, for craniofacial surgery. One hundred twenty patients with American Society of Anesthesiologists (ASA) classification of I or II patients, 18 to 32 years old, and undergoing maxillary and mandibular osteotomies were randomly assigned to receive anesthesia with propofol-remifentanil (group P), desflurane-remifentanil (group D), or sevoflurane-remifentanil (group S). All patients were given premedication: midazolam 0.03 mg/kg, atropine 0.007 mg/kg, desametasone 0.1 mg/kg, NaCl 0.9% 100 mL + 2 mg/kg ketoprofene + 1.5 mg/kg ranitidine + 1 microg/kg clonidine. ⋯ Hypotension was successfully obtained in all three groups with a bloodless surgical field, and there was no need for additional use of a potent hypotensive agent. Early and late recovery were faster and more complete in the D group; P < 0.05. Postoperative morbidity (nausea, vomiting, shivering, pain, and edema) was slight and did not significantly differ among the groups.
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Randomized Controlled Trial Clinical Trial
Postoperative pain management using intravenous patient-controlled analgesia for pediatric patients.
Pain control is an important consideration after any surgical procedures. Especially in children, more attention and care are needed during the period of postoperative pain control, which must be both sufficiently safe and effective. In this respect, intravenous patient-controlled analgesia provides improved titration of analgesic drugs, thereby maintaining optimal analgesic status with few side effects. ⋯ The degree of analgesia was assessed every 4 hours until the second postoperative day. The intravenous patient-controlled analgesia group had significantly lower pain scores and took less time until they were able to walk to the bathroom, but as many side effects as the control group. We concluded that intravenous patient-controlled analgesia is safe and effective for pediatric patients who have moderate to severe pain after operations such as rib cartilage graft, iliac bone graft, and large flap surgeries.
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Randomized Controlled Trial Clinical Trial
Prophylactic use of ondansetron for emesis after craniofacial operations in children.
Children who undergo craniofacial operations are especially at risk of postoperative nausea and vomiting. These operations are more complex than the craniotomies for resective procedures. Postoperative vomiting is a common occurrence that can delay recovery and result in cerebrospinal fluid leak and fistula formation in these patients. ⋯ After surgery, episodes of vomiting were recorded separately in 0 to 2 hours, 2 to 6 hours, 6 to 12 hours, 12 to 24 hours, and 24 to 48 hours. Postoperative vomiting is significantly reduced in the ondansetron group compared with the placebo group (P = 0.000258). Ondansetron is effective in the prevention of postoperative vomiting in the pediatric population undergoing craniofacial operations.