title: Metabolic changes and factors influencing base deficit in infants undergoing craniosynostosis surgery: a retrospective study.
abstract: BACKGROUND
  Corrective craniosynostosis surgery is often associated with a large amount of blood loss and metabolic disturbances. In the present study, we investigated the severity, duration of metabolic disturbances, and causal risk factors in infants.
  
  
  METHODS
  A retrospective analysis was performed of 36 infants who underwent craniosynostosis surgery. We analyzed the following: demographics, duration of surgery, intraoperative blood loss, RBC, FFP and fluids transfused, urine output, hemodynamic parameters, and electrolyte and base deficit (BD) values. The lowest intraoperative BD value and time required (period I: <6 h; period II: 6-12 h; period III: >12 h) for BD values to return to normal (-4 to +2) in the postoperative period were determined. In addition, we recorded the postoperative length of stay in the ICU and hospital, postoperative blood loss, and early complications.
  
  
  RESULTS
  We detected that 88% of the patients had subnormal BD levels and 22% had metabolic acidosis. The lowest average BD measured during the operation was -8.4 ± 2.6 mmol/l. We carried out a multiple regression analysis, which revealed that lower BD values were associated with a longer duration of hypotension (p = 0.002, R(2) = 0.453) and greater intraoperative blood loss (p = 0.002, R(2) = 0.674). We examined the amount of intraoperative blood loss and found that that there were fewer blood product transfusions in period I patients and longer hypotensive episodes in period III patients. Also, a negative correlation was detected between the lowest intraoperative BD value with ICU duration (p = 0.004, r = -0.466) and hospital stay (p < 0.001, r = -0.764).
  
  
  CONCLUSIONS
  Almost all patients developed intraoperative negative BD, which was prolonged in the postoperative period. The most important risk factors for developing negative BD are the amount of blood loss and duration of hypotension.
authors.affiliation: Istanbul Faculty of Medicine, Department of Anesthesiology and Reanimation Fatih, Istanbul University, Istanbul, Turkey.
authors.forename: Achmet
authors.initials: A
authors.lastname: Ali
authors.forename: Burcu
authors.initials: B
authors.lastname: Basaran
authors.forename: Gamze
authors.initials: G
authors.lastname: Tanirgan
authors.forename: Aydin
authors.initials: A
authors.lastname: Aydoseli
authors.forename: Pulat Akin
authors.initials: PA
authors.lastname: Sabanci
authors.forename: Altay
authors.initials: A
authors.lastname: Sencer
authors.forename: Lutfi
authors.initials: L
authors.lastname: Telci
authors.forename: Ibrahim Ozkan
authors.initials: IO
authors.lastname: Akinci
mesh_terms: D000137:Acid-Base Imbalance / Q000209:etiology*; D016063:Blood Loss, Surgical; D003398:Craniosynostoses / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014882:Water-Electrolyte Balance / Q000502:physiology*