Metabolic changes during major craniofacial surgery (Prospective Observational Study of the Metabolic Status of Children Undergoing Major Craniofacial Surgery)

Arnwald Choi (1) , Nargis Ahmad (2) , D Ah de Beer (3)

1 Anaesthesia
2 Anaesthesia
3 Department of Anaesthesia

OBJECTIVES The purpose of this study was to document the degree and duration of perioperative metabolic disturbance during major craniofacial surgery in children. AIM The aim was to quantify the degree and duration of perioperative metabolic disturbance and secondly to determine the relationship between the metabolic changes and the duration of surgery and total volume of blood and colloid given during surgery. BACKGROUND These patients have the potential for massive blood loss and significant metabolic acidosis. Routine perioperative monitoring includes the serial measurement of base deficit as a marker of metabolic disturbance. METHODS/MATERIALS All patients undergoing elective major craniofacial surgery were prospectively studied over a 10-month period. Base deficit from arterial blood gas analysis was measured at standardised intervals during the perioperative period. The duration of surgery and total volume of blood and colloid given intraoperatively were used as covariates in a multiple regression analysis. RESULTS Maximum recorded base deficit ranged from -3 to -20 (median -9). Median time taken to return to normal was 9.25h (range 0-18h). Median duration of significant base deficit was 3.8h (range 0-20h). CONCLUSIONS Children undergoing major craniofacial surgery develop a varying degree of perioperative metabolic acidosis persisting for several hours. The maximum base deficit appears to be related to the amount of intraoperative blood loss and replacement rather than duration of surgery. As it is difficult to predict the extent and duration of metabolic acidosis for an individual patient, this study confirmed our current practice that all patients should be admitted to a neurosurgical high dependency unit postoperatively for overnight monitoring.

Mots clés: Medicine

Arnwald Choi, Nargis Ahmad, D Ah de Beer. Metabolic changes during major craniofacial surgery (Prospective Observational Study of the Metabolic Status of Children Undergoing Major Craniofacial Surgery). Pediatric Anesthesia, 2010, 20 (9), pp.851. ⟨10.1111/j.1460-9592.2010.03370.x⟩. ⟨hal-00566760⟩