title: Anaesthetic management in facial bipartition surgery: the experience of one centre.
abstract: Facial bipartition is amongst the most radical craniofacial surgery undertaken but is performed rarely. There is little published information on its anaesthetic management. We undertook a retrospective case-note review of 22 consecutive patients undergoing bipartition surgery by the same surgical team in one centre in the period 1993-2001. There were incomplete data for two cases and these were therefore excluded. Patients were aged 2 months to 19 years. Conditions treated were facial cleft (n = 5), frontonasal dysplasia (n = 7) and facial dysostosis (n = 8).Intra-operative complications included major haemorrhage (n = 4), bradycardia (n = 3) and unintentional tracheal extubation (n = 1). There were no peri-operative deaths. All patients required intra-operative blood transfusion and 15% of them had a postoperative haemoglobin concentration > 115% of their pre-operative value. In this series, four patients required postoperative lung ventilation for a median duration of 3 days. Infants < 14 months old were significantly more likely to receive a massive blood transfusion (p = 0.0002), to have an excessively high postoperative haematocrit (p = 0.008) and to require postoperative lung ventilation (p = 0.0002) compared with older patients. We conclude that patients in this age group have a significantly increased risk of postoperative complications.
authors.affiliation: Department of Anaesthesia, Great Ormond Street Hospital, London WC1, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mallory
authors.forename: L H
authors.initials: LH
authors.lastname: Yap
authors.forename: B M
authors.initials: BM
authors.lastname: Jones
authors.forename: R
authors.initials: R
authors.lastname: Bingham
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000768:Anesthesia, General / Q000379:methods*; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D019465:Craniofacial Abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D005440:Fluid Therapy; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D010027:Osteotomy / Q000379:methods*; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D006454:Hemoglobins