• E Frebet, M P Preckel, N Poirier, P Mercier, and J C Granry.
• Département d'anesthésie-réanimation, centre hospitalier universitaire, Angers, France.
• Ann Fr Anesth Reanim. 2000 Apr 1;19(4):237-41.

ObjectiveTo evaluate the changes in transfusion practices during craniosynostosis surgery in children, with consideration of the transfusion-associated risks.Study DesignRetrospective study.PatientsThe study included 64 consecutive craniosynostosis repairs by the same neurosurgical and anaesthetic team, over a period of 17 years.MethodsThe children were allocated into two groups. In group I (1980-1991), blood loss was compensated precisely from scalp incision on. In group II (1992-1996), transfusion was only started when blood loss crossed a calculated limit considered as acceptable. The mean criterion of judgment was the quantity of transfused blood in comparison with the theoretical blood volume. Mean preoperative and postoperative haemoglobin concentrations, estimated blood losses, volume of replaced blood and number of transfused patients were compared between the two groups with a two tailed Student's t test.ResultsThe rate of non transfused children increased from 6% before 1991 to 39% after 1992%; conservely the rate of postoperative transfusions increased from 3 to 39%.ConclusionThe risks of blood transfusion favoured the development of new of more restrictive transfusion practices, even in haemorrhagic surgery. To limit blood transfusion in craniosynostosis surgery, a harmonious cooperation between surgeons and anaesthetists is essential and blood replacement must be based on a definite determination of the acceptable blood losses.

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