title: Duration of mechanical ventilation after craniosynostosis repair reduces over time.
abstract: BACKGROUND
  Pediatric craniosynostosis repair (CR) involves wide scalp dissections with multiple osteotomies and has been associated with significant morbidity. The aim of this study was to document the impact of perioperative complications on prolonged mechanical ventilation after CR.
  
  
  METHODS
  Data were collected from the anesthesia records, Pediatric Intensive Care Unit (PICU) progress notes and discharge summaries. All the patients were transferred from the operating room sedated and on mechanical ventilation to the PICU. To highlight the determinants of prolonged mechanical ventilation we performed a logistic regression analysis..
  
  
  RESULTS
  Fifty-five patients underwent CR, but 6 were excluded due to incomplete records. The main intraoperative complications were: metabolic acidosis (32%), hypotension (20%), dural tears laceration (22%) and altered coagulation (18%). Metabolic acidosis (46%) and relative polycythemia (24%) were detected on arrival to the PICU. All children received intraoperative blood products and 23 (46%) were transfused in the postoperative period too. No infective complications were detected. The only determinant associated significantly with a prolonged mechanical ventilation was to have surgery in the first 5 years of the program (P=0.05) (95% CI 0.358-0.996).
  
  
  CONCLUSIONS
  All life-threatening complications were intraoperative whereas only milder ones, such as hypercloremic and lactic acidosis were noticed in PICU. All children are alive without any neurological deficit. Even though we deal on a daily basis with complex surgical cases, only time, hence experience, showed an impact on prolonged mechanical ventilation.
authors.affiliation: Department of Anesthesia, Ospedale Papa Giovanni XXIII of Bergamo, Bergamo, Italy - floriana.ferrari@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Ferrari
authors.forename: M
authors.initials: M
authors.lastname: Nacoti
authors.forename: B G
authors.initials: BG
authors.lastname: Locatelli
authors.forename: D
authors.initials: D
authors.lastname: Corbella
authors.forename: M
authors.initials: M
authors.lastname: Khotcholava
authors.forename: I
authors.initials: I
authors.lastname: Pellicioli
authors.forename: A
authors.initials: A
authors.lastname: Cassisi
authors.forename: V
authors.initials: V
authors.lastname: Sonzogni
mesh_terms: D000758:Anesthesia; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D011182:Postoperative Care; D012121:Respiration, Artificial; D012189:Retrospective Studies