Craniofaciosynostosis: anesthetic and perioperative management. Report of 71 operations.

Faciocranial dysmorphisms are at the present time corrected during very complex procedures aiming at functional, esthetic and psychological improvement. The authors present their 9 years experience of 71 operations. The age at which those operations are performed is between 6 and 12 months for 14 patients (20%) and under 6 months for 34 patients (48%), the youngest patient being 6 weeks old. Per- and post-operative problems are reviewed. Mean surgical time is 210 minutes. The anesthetic approach aims at reducing the size of the brain by the use of osmotic diuresis, slight hyperventilation, moderate induced hypotension and semi-sitting position. The hemodynamic monitoring includes for all patients an arterial line and a central venous catheter. Blood loss can be large and sometimes sudden; it amounts in average to 62% of patient's estimated blood volume (12 to 200%). The most frequently encountered complications are cardiac dysrhythmias (mainly bradycardia 15 cases), accidental venous sinus opening (2 cases), post-extubation glottic edema (5 cases) and postoperative cerebrospinal leak (2 cases). No long-term sequelae persist from those incidents. There is neither infection, nor perioperative mortality. From those results, the authors consider that infants with craniofaciosynostosis can be operated upon and their dysmorphy corrected with a low perioperative risk. However successful prevention of complications and functional result depend essentially on a multidisciplinary approach, in well-equipped hospitals.