Craniofacial (Well, more cranio than facial)

[ZA_Gasman]

Hi all.

Dumb question maybe, but....
Looking for a bit of advice. My second case tomorrow is a 2 month 5.8kg (~3,2 lbs?) ex term baby with craniosynostosis of saggital and metopic sutures. Planned procedure is bi-coronal flap and bilateral para-saggital craniectomy. Given that total blood volume is approx 450-500ml, am expecting massive transfusion, and blood ordered is commensurate with that fear. PICU bed arranged etc.

It occurrs to me that cell saving may be a possibility here. Any one have any experience? Would you process the banked blood through the cell saver to wash it anyway? Any thoughts welcome, Thanks

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[rn29306]

Uh.....Man good luck with that case. We do them at our hospital and they can be quite hairy. Surgeon puts in a single lumen femoral large bore cath that we attach to our hotline. Aline and PIV then prone positioning usually.

Bleeding you say? Kind of like major burn debridement down here. We start gtt'ing blood as soon as possible. We always put a 3 way stop cock distal to the blood warmer and invariably, have to withdraw blood from the bag and start infusing it 30mls at a time from the bleeding...in addition to what is running in the line. We have always used cellsaver on our kiddos.

Let us know how it goes.

 

[dhb]

5.8kg (~3,2 lbs?)

more like 12lbs

 

[ZA_Gasman]

Oops. Never did quite get that conversion right. Divided when I should have multiplied. What a t**t

 

[EV-Stentor]

Oops. Never did quite get that conversion right. Divided when I should have multiplied. What a t**t

Simply multiply weight in Kg by 2.2 to give weight in lbs...this makes the case a lot easier i.e 3.2lbs vs 12lbs...
Given the high risk of air embolism here I would place a RIJ central line and forgo placing a Femoral cordis...i.e kill 2 birds with one stone....suction out venous air if need be and at the same time have a central vascular access for rapid resuscitartion.
Goodluck with the case dude / dudette
btw those baby A line can be a pain. I use a regular 22g angiocath and hook it up to tanducer set up..Peace

 

[ZA_Gasman]

Well, just finished the above case. Bit of an anticlimax really, but that was probably because so well prepared. CVP in R IJ, problematic but eventually successful. A-line R post tib, which was a real pain, but useful anyway. Total blood loss - about 200ml. Extubated and to PICU. No problem. Seems our brain surgeons brought their brains today.
Thanks for the advice though
BTW EV-stentor - it is dude.
Tx

 

[jwk]

For future reference on the cellsaver...

During the salvaging and processing of the RBC's, as much as half of the red cells in the reservoir will be lost from hemolysis and/or washout. The smallest sized centrifuge bowl for the machine is 125cc. You'll need 300-400 cc of actual blood loss to fill up that 125cc bowl with red cells once the processing is done.

Also - remember that the product you get in the end is a suspension of RBC's in saline. That's it. No plasma, no clotting factors.

For tiny patients, cellsaver use would not be indicated, but it is used in larger kids, especially things like big spine cases and other high blood loss procedures.