Abstract

Craniosynostosis, the premature fusion of cranial sutures, is a critical issue in pediatric patients undergoing cranial vault remodeling (CVR). Early diagnosis and surgical intervention are essential to prevent complications and promote normal brain growth. Although CVR has proven to be beneficial, the surgical procedure carries the risk of substantial blood loss and transfusion related complications. In fact, over 80% of patients undergoing cranial vault reconstructions require blood transfusions. Multiple studies have shown that unjustifiable transfusions depletes financial resources and increases the risk of complications such as DVTs, acute kidney injuries, sepsis and more. Addressing these challenges, the utilization of tranexamic acid or TXA emerges as a pivotal solution. TXA is an antifibrinolytic agent with a short half-life of 2 hours that inhibits the breakdown of blood clots by binding to plasminogen. In this case report, a full term 12-month-old male diagnosed with sagittal craniosynostosis underwent a bifrontal craniectomy with barrel stave osteotomies for calvarial vault reconstruction and sagittal suture remodeling. The patient's medical history included resolved thrombocytopenia, a family history of Von Willebrand's disease, and malignant hyperthermia. The patient was placed under a non-triggering general anesthetic using intravenous propofol and ketamine infusions and a cuffed endotracheal tube for controlled positive pressure ventilation. Despite initial hemodynamic stability, intraoperative challenges arose, marked by significant blood loss of approximately 350 mL, prompting a transfusion of 300 mL of packed red blood cells. Postoperatively, the patient experienced a continuous decline in hemoglobin and hematocrit levels from 12.3 g/dL to 6.8 g/dL and from 38% to 18.8% respectively, necessitating additional transfusions. However, the outcomes might have been altered with the implementation of additional blood-loss reduction strategies.

Clinical Question:

Would the administration of intraoperative tranexamic acid to pediatric patients undergoing cranial vault reconstruction safely reduce blood loss and blood transfusions?

Author Details

Claudia Means BSN, RN Terri Cahoon, DNP, CRNA

Sigma Membership

Non-member

Lead Author Affiliation

Samford University, Birmingham, Alabama, USA

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Intraoperative Tranexamic Acid, Craniosynostosis, Hemostasis

Advisor

Cahoon, Terri

Degree

DNP

Degree Grantor

Samford University

Degree Year

2024

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Self-submission

Date of Issue

2024-01-26

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