Dallas and Houston, Texas From the Craniofacial Center; the Craniofacial and Plastic Surgery Center; and the Department of Research, Medical City Dallas Hospital.
Plast Reconstr Surg. 2014 May;133(5):1133-1136. doi: 10.1097/PRS.0000000000000108.
Hypotensive anesthesia is routinely used during craniosynostosis corrections to reduce blood loss. Noting that cerebral oxygenation levels often fell below recommended levels, the authors sought to measure the effects of hypotensive versus standard anesthesia on blood transfusion rates.
One hundred children undergoing craniosynostosis corrections were randomized prospectively into two groups: a target mean arterial pressure of either 50 mm Hg or 60 mm Hg. Aside from anesthesiologists, caregivers were blinded and strict transfusion criteria were followed. Multiple variables were analyzed, and appropriate statistical testing was performed.
The hypotensive and standard groups appeared similar, with no statistically significant differences in mean age (46.5 months versus 46.5 months), weight (19.25 kg versus 19.49 kg), procedure [anterior remodeling (34 versus 31) versus posterior (19 versus 16)], or preoperative hemoglobin level (13 g/dl versus 12.9 g/dl). Intraoperative mean arterial pressures differed significantly (56 mm Hg versus 66 mm Hg; p < 0.001). The captured cell saver amount was lower in the hypotensive group (163 cc versus 204 cc; p = 0.02), yet no significant differences were noted in postoperative hemoglobin levels (8.8 g/dl versus 9.3 g/dl). Fifteen of 100 patients (15 percent) received allogenic transfusions, but no statistically significant differences were noted in transfusion rates between the hypotensive [nine of 53 (17.0 percent)] and standard anesthesia [six of 47 (13 percent)] group (p = 0.056).
No significant difference in transfusion requirements was found between hypotensive and standard anesthesia during craniosynostosis corrections. Considering potential benefits of improved cerebral blood flow and total body perfusion, surgeons might consider performing craniosynostosis corrections without hypotension.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
在颅缝早闭矫正术中，常采用低血压麻醉以减少失血量。由于发现脑氧合水平经常低于推荐水平，作者试图测量低血压与标准麻醉对输血率的影响。
100 例接受颅缝早闭矫正术的儿童被前瞻性随机分为两组：目标平均动脉压分别为 50mmHg 或 60mmHg。除麻醉师外，护理人员均为盲法，严格遵循输血标准。分析了多个变量，并进行了适当的统计学检验。
低血压组和标准组似乎相似，平均年龄（46.5 个月对 46.5 个月）、体重（19.25kg 对 19.49kg）、手术方式[前颅面骨重塑（34 例对 31 例）对后颅面骨（19 例对 16 例）]或术前血红蛋白水平（13g/dl 对 12.9g/dl）均无统计学差异。术中平均动脉压差异显著（56mmHg 对 66mmHg；p＜0.001）。低血压组采集的细胞保存量较低（163cc 对 204cc；p=0.02），但术后血红蛋白水平无显著差异（8.8g/dl 对 9.3g/dl）。100 例患者中有 15 例（15%）接受了同种异体输血，但低血压组[53 例中的 9 例（17.0%）]和标准麻醉组[47 例中的 6 例（13%）]之间的输血率无统计学差异（p=0.056）。
在颅缝早闭矫正术中，低血压与标准麻醉在输血需求方面无显著差异。考虑到改善脑血流和全身灌注的潜在益处，外科医生可能会考虑在不使用低血压的情况下进行颅缝早闭矫正。
临床问题/证据水平：治疗性，II 级。
