A Clinical Pilot Study of Fresh Frozen Plasma versus Human Albumin in Paediatric Craniofacial Repair

Abstract

Paediatric craniofacial surgery (pCFS) regularly requires transfusion of packed red blood cells (pRBC). In this clinical pilot study two different transfusion regimens were prospectively compared concerning pRBC transfusions, postoperative bleeding and other clinical parameters. Thirty infants (aged < 12 months) scheduled for pCFS were assigned to receive fresh frozen plasma (FFP-group, n = 15) or 5% human albumin (HA-group, n = 15) during the entire surgical procedure. Perioperative amounts of pRBC, postoperative bleeding, major complications, duration of stay in the intensive care unit and overall hospital stay were compared. Differences in pRBC transfusions, postoperative bleeding, and duration of intensive care unit stay were not significant and no major complications occurred in either group. A significantly shorter overall hospital stay was observed in favour of the FFP-group. Volume replacement during pCFS can be safely performed with both applied protocols. Our data do not demonstrate a major advantage for FFP use, but further evaluation is necessary.

Keywords

Craniosynostosis Paediatric anaesthesia Volume replacement Transfusion management Fresh frozen plasma Human albumin Packed red blood cells

References

Kabbani

Raghuveer

: Craniosynostosis. Am Fam Physician 2004; 69: 2863–2870.

Panchal

Uttchin

: Management of craniosynostosis. Plast Reconstr Surg 2003; 111: 2032–2048.

Haberl

Hell

Zockler

: Technical aspects and results of surgery for craniosynostosis. Zentralbl Neurochir 2004; 65: 65–74.

Faberowski

Black

Mickle

: Blood loss and transfusion practice in the perioperative management of craniosynostosis repair. J Neurosurg Anesthesiol 1999; 11: 167–172.

Williams

Ellenbogen

Gruss

: Abnormal coagulation during pediatric craniofacial surgery. Pediatr Neurosurg 2001; 35: 5–12.

Hobisch-Hagen

: Hemodilution and coagulation. An overview. Minerva Anestesiol 2002; 68: 178–181.

Lam

Chan

: In vivo effect of haemodilution with saline on coagulation: A randomized controlled trial. Br J Anaesth 2002; 88: 475–480.

Ruttmann

: Haemodilution enhances coagulation. Br J Anaesth 2002; 88: 470–472.

Casbard

Williamson

Murphy

: The role of prophylactic fresh frozen plasma in decreasing blood loss and correcting coagulopathy in cardiac surgery. A systematic review. Anaesthesia 2004; 59: 550–558.

10.

Wernecke

: Operational Practical Statistics. Bonn/ Paris: Addison-Wesley, 1995 [in German].

11.

Buntain

Pabari

: Massive transfusion and hyperkalaemic cardiac arrest in craniofacial surgery in a child. Anaesth Intensive Care 1999; 27: 530–533.

12.

Kang

Lee

Baik

: Perioperative specific management of blood volume loss in craniosynostosis surgery. Childs Nerv Syst 1998; 14: 297–301.

13.

Levine

Stelnicki

Weiner

: Hyponatremia in the postoperative craniofacial pediatric patient population: A connection to cerebral salt wasting syndrome and management of the disorder. Plast Reconstr Surg 2001; 108: 1501–1508.

14.

Nishimoto

Oyama

Shimizu

: Fronto-facial monobloc advancement with rigid external distraction (RED-II) system. J Craniofac Surg 2004; 15: 54–59.

15.

Eaton

Marsh

Pilgram

: Transfusion requirements for craniosynostosis surgery in infants. Plast Reconstr Surg 1995; 95: 277–283.

16.

Meyer

Renier

Arnaud

: Blood loss during repair of craniosynostosis. Br J Anaesth 1993; 71: 854–857.

17.

Di Rocco

Tamburrini

Pietrini

: Blood sparing in craniosynostosis surgery. Semin Pediatr Neurol 2004; 11: 278–287.

18.

Fearon

Weinthal

: The use of recombinant erythropoietin in the reduction of blood transfusion rates in craniosynostosis repair in infants and children. Plast Reconstr Surg 2002; 109: 2190–2196.

19.

Jimenez

Barone

: Intraoperative autologous blood transfusion in the surgical correction of craniosynostosis. Neurosurgery 1995; 37: 1075–1079.

20.

Jimenez

Barone

Cartwright

: Early management of craniosynostosis using endoscopic-assisted strip craniectomies and cranial orthotic molding therapy. Pediatrics 2002; 110: 97–104.

21.

Meneghini

Zadra

Aneloni

: Erythropoietin therapy and acute preoperative normovolaemic haemodilution in infants undergoing craniosynostosis surgery. Paediatr Anaesth 2003; 13: 392–396.

22.

Ririe

David

Glazier

: Surgical advancement influences perioperative care: A comparison of two surgical techniques for sagittal craniosynostosis repair. Anesth Analg 2003; 97: 699–703.

23.

Innerhofer

Fries

Klingler

: In vivo effect of haemodilution with saline on coagulation. Br J Anaesth 2002; 89: 934–936.

24.

Ruttmann

James

: Haemodilution and coagulation: A caveat. Anasthesiol Intensivmed Notfallmed Schmerzther 2000; 35: 707–709.

25.

Oliver

Jr. Beynen

Nuttall

: Blood loss in infants and children for open heart operations: Albumin 5% versus fresh-frozen plasma in the prime. Ann Thorac Surg 2003; 75: 1506–1512.