title: Controlled hypotension and blood loss during frontoorbital advancement.
abstract: OBJECTIVE
  Controlled hypotension is routinely used during open repair of craniosynostosis to decrease blood loss, although this benefit is unproven. In this study the authors analyzed the longitudinal relationships between intraoperative mean arterial pressure (MAP) and calculated blood loss (CBL) during frontoorbital advancement (FOA) for craniosynostosis.
  
  
  METHODS
  The authors reviewed the records of infants with craniosynostosis who had undergone primary FOA between 1997 and 2009. Anesthesia records provided preoperative and serial intraoperative MAP. Interval measures of CBL had been determined during the course of the operation. The longitudinal relationships between MAP(mean), MAP(change), and CBL(change) were assessed over the same time interval and compared between adjacent time intervals to determine the directionality of associations.
  
  
  RESULTS
  Ninety infants (44 males and 46 females) underwent FOA at a mean age and weight of 10.7 ± 12.9 months and 9.0 ± 7.0 kg, respectively. The average intraoperative MAP was 56.1 ± 4.8 mm Hg, 22.6 ± 12.1% lower than preoperative baseline. A negative correlation was found between CBL(change) and MAP(mean) over the same interval (r = -0.31, p < 0.05), and an inverse relationship was noted between CBL(change) of the previous interval and MAP(change) of the next interval (r = -0.07, p < 0.05). Finally, there was no significant association between MAP(change) of the previous interval and CBL(change) of the next interval.
  
  
  CONCLUSIONS
  Calculated blood loss demonstrated a negative correlation with MAP during FOA. Directionality testing indicated that MAP did not affect intraoperative blood loss; instead, blood loss drove changes in MAP. Overall, these findings challenge the benefit of controlled hypotension during open craniofacial repair.
authors.affiliation: Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA.
authors.forename: Mitchel
authors.initials: M
authors.lastname: Seruya
authors.forename: Albert K
authors.initials: AK
authors.lastname: Oh
authors.forename: Gary F
authors.initials: GF
authors.lastname: Rogers
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Boyajian
authors.forename: John S
authors.initials: JS
authors.lastname: Myseros
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Yaun
authors.forename: Robert F
authors.initials: RF
authors.lastname: Keating
mesh_terms: D000375:Aging / Q000502:physiology; D000465:Algorithms; D016063:Blood Loss, Surgical / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology; D003398:Craniosynostoses / Q000601:surgery*; D005260:Female; D005624:Frontal Bone / Q000601:surgery*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007023:Hypotension, Controlled / Q000379:methods*; D007223:Infant; D007430:Intraoperative Care; D008137:Longitudinal Studies; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D009915:Orbit / Q000601:surgery*
chemical_list: D006454:Hemoglobins