title: Time-dependent perioperative anesthetic management and outcomes of the first 100 consecutive cases of spring-assisted surgery for sagittal craniosynostosis.
abstract: BACKGROUND
  The anesthetic risks and outcomes of the first 100 consecutive spring-assisted surgeries (SAS) for cranial expansion from a single institution are reported. The effect of number of procedures was also tested on hematocrit postoperative day 1 (POD1), anesthesia time, and surgery time of the first procedure.
  
  
  METHODS
  The records of 100 consecutive patients undergoing SAS were reviewed. Anesthesia management and related complications are presented. Time series linear regression analysis was performed on hematocrit POD1, anesthesia time, and surgery time of the first procedure.
  
  
  RESULTS
  The average age of the first insertion procedure was 4.4 and 9.0 months for the second removal procedure. Two patients were inadvertently extubated during positioning. Thirty-eight children had a decrease in blood pressure >20% from baseline. No child was admitted to the intensive care unit. No patient received any blood or blood product transfusion. Anesthesia time, surgery time, and hematocrit POD1 were correlated with procedure number or experience.
  
  
  CONCLUSIONS
  Changes in anesthetic management resulted from changing the procedure. The reduction in volume resuscitation reduces the need for invasive monitoring. Facility and comfort with the surgical procedure increase with time and number of procedures performed. This experience further reduces blood loss and risk of transfusion.
authors.affiliation: Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA. dririe@wfubmc.edu
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Ririe
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Smith
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Wood
authors.forename: Steven S
authors.initials: SS
authors.lastname: Glazier
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Couture
authors.forename: Louis C
authors.initials: LC
authors.lastname: Argenta
authors.forename: Lisa R
authors.initials: LR
authors.lastname: David
mesh_terms: D000758:Anesthesia; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D001803:Blood Transfusion; D003398:Craniosynostoses / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006400:Hematocrit; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D008738:Methyl Ethers; D016343:Monitoring, Intraoperative; D019990:Perioperative Care; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D000077149:Sevoflurane; D012886:Skull / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane