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22 - Anesthesia for Plastic Surgery

from Section 3 - Specific Newborn and Infant Procedures

Published online by Cambridge University Press:  09 February 2018

By
Petra M. Meier
Edited by
Mary Ellen McCann
Edited in association with
Christine Greco  and
Kai Matthes
Mary Ellen McCann
Affiliation:
Harvard Medical School, Boston, MA, USA
Christine Greco
Affiliation:
Harvard Medical School, Boston, MA, USA
Kai Matthes
Affiliation:
Harvard Medical School, Boston, MA, USA
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Essentials of Anesthesia for Infants and Neonates , pp. 211 - 232
Publisher: Cambridge University Press
Print publication year: 2018

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References

1.Mulliken, JB, MacDonald, DM. Cleft lip/palate and Robin sequence. In Hansen, A, Puder, M, editors. Manual of Neonatal Surgical Intensive Care, 2nd edition. Shelton, CT: People’s Medical Publishing House; 2009.Google Scholar
2.Milerad, J, Larson, O, Ph, DD, Hagberg, C, Ideberg, M. Associated malformations in infants with cleft lip and palate: a prospective, population-based study. Pediatrics. 1997;100(2 Pt 1):180–6.Google Scholar
3.Evans, AK, Rahbar, R, Rogers, GF, Mulliken, JB, Volk, MS. Robin sequence: a retrospective review of 115 patients. Int J Pediatr Otorhinolaryngol. 2006;70(6):973–80.CrossRefGoogle ScholarPubMed
4.Butow, KW, Hoogendijk, CF, Zwahlen, RA. Pierre Robin sequence: appearances and 25 years of experience with an innovative treatment protocol. J Pediatr Surg. 2009;44(11):2112–18.Google Scholar
5.Cladis, F, Kumar, A, Grunwaldt, L, et al. Pierre robin sequence: a perioperative review. Anesth Analg. 2014;119(2):400–12.Google Scholar
6.Takemura, H, Yasumoto, K, Toi, T, Hosoyamada, A. Correlation of cleft type with incidence of perioperative respiratory complications in infants with cleft lip and palate. Paediatr Anaesth. 2002;12(7):585–8.Google Scholar
7.Jackson, O, Basta, M, Sonnad, S, et al. Perioperative risk factors for adverse airway events in patients undergoing cleft palate repair. Cleft Palate Craniofac J. 2013;50(3):330–6.Google Scholar
8.Xue, FS, Zhang, GH, Li, P, et al. The clinical observation of difficult laryngoscopy and difficult intubation in infants with cleft lip and palate. Paediatr Anaesth. 2006;16(3):283–9.Google Scholar
9.Gunawardana, RH. Difficult laryngoscopy in cleft lip and palate surgery. Br J Anaesth. 1996;76(6):757–9.Google Scholar
10.Uezono, S, Holzman, RS, Goto, T, et al. Prediction of difficult airway in school-aged patients with microtia. Paediatr Anaesth. 2001;11(4):409–13.Google Scholar
11.Nargozian, C. The airway in patients with craniofacial abnormalities. Paediatr Anaesth. 2004;14(1):53–9.CrossRefGoogle ScholarPubMed
12.Ahuja, S, Datta, A, Krishna, A, Bhattacharya, A. Infra-orbital nerve block for relief of postoperative pain following cleft lip surgery in infants. Anaesthesia. 1994;49(5):441–4.CrossRefGoogle ScholarPubMed
13.Rajamani, A, Kamat, V, Rajavel, VP, Murthy, J, Hussain, SA. A comparison of bilateral infraorbital nerve block with intravenous fentanyl for analgesia following cleft lip repair in children. Paediatr Anaesth. 2007;17(2):133–9.Google Scholar
14.Takmaz, SA, Uysal, HY, Uysal, A, et al. Bilateral extraoral, infraorbital nerve block for postoperative pain relief after cleft lip repair in pediatric patients: a randomized, double-blind controlled study. Ann Plast Surg. 2009;63(1):59–62.Google Scholar
15.Simion, C, Corcoran, J, Iyer, A, Suresh, S. Postoperative pain control for primary cleft lip repair in infants: is there an advantage in performing peripheral nerve blocks? Paediatr Anaesth. 2008;18(11):1060–5.Google Scholar
16.Bosenberg, AT, Kimble, FW. Infraorbital nerve block in neonates for cleft lip repair: anatomical study and clinical application. Br J Anaesth. 1995;74(5):506–8.Google Scholar
17.Bell, C, Oh, TH, Loeffler, JR. Massive macroglossia and airway obstruction after cleft palate repair. Anesth Analg. 1988;67(1):71–4.Google Scholar
18.Lee, JT, Kingston, HG. Airway obstruction due to massive lingual oedema following cleft palate surgery. Can Anaesth Soc J. 1985;32(3 Pt 1):265–7.Google Scholar
19.Cohen, MM, Jr., MacLean, RE. Craniosynostosis: Diagnosis, Evaluation, and Management, 2nd edn. New York: Oxford University Press; 2000.Google Scholar
20.Tamburrini, G, Caldarelli, M, Massimi, L, Santini, P, Di Rocco, C. Intracranial pressure monitoring in children with single suture and complex craniosynostosis: a review. Childs Nerv Syst. 2005;21(10):913–21.CrossRefGoogle ScholarPubMed
21.McCarthy, JG, Warren, SM, Bernstein, JM, et al. Parameters of care for craniosynostosis. Cleft Palate Craniofac J. 2011;49:1S–24S.Google Scholar
22.Church, MW, Parent-Jenkins, L, Rozzelle, AA, Eldis, FE, Kazzi, SN. Auditory brainstem response abnormalities and hearing loss in children with craniosynostosis. Pediatrics. 2007;119(6):e1351–60.CrossRefGoogle ScholarPubMed
23.Hertle, RW, Quinn, GE, Minguini, N, Katowitz, JA. Visual loss in patients with craniofacial synostosis. J Pediatr Ophthalmol Strabismus. 1991;28(6):344–9.Google Scholar
24.Renier, D, Sainte-Rose, C, Marchac, D, Hirsch, JF. Intracranial pressure in craniostenosis. J Neurosurg. 1982;57(3):370–7.Google Scholar
25.Connolly, JP, Gruss, J, Seto, ML, et al. Progressive postnatal craniosynostosis and increased intracranial pressure. Plast Reconstr Surg. 2004;113(5):1313–23.Google Scholar
26.Mulliken, JB, Vander Woude, DL, Hansen, M, LaBrie, RA, Scott, RM. Analysis of posterior plagiocephaly: deformational versus synostotic. Plast Reconstr Surg. 1999;103(2):371–80.CrossRefGoogle ScholarPubMed
27.Laughlin, J, Luerssen, TG, Dias, MS. Prevention and management of positional skull deformities in infants. Pediatrics. 2011;128.Google Scholar
28.Hoeve, LJ, Pijpers, M, Joosten, KF. OSAS in craniofacial syndromes: an unsolved problem. Int J Pediatr Otorhinolaryngol. 2003;67(Suppl. 1):S111–13.CrossRefGoogle ScholarPubMed
29.Pijpers, M, Poels, PJ, Vaandrager, JM, et al. Undiagnosed obstructive sleep apnea syndrome in children with syndromal craniofacial synostosis. J Craniofac Surg. 2004;15(4):670–4.Google Scholar
30.De Jong, T, Bannink, N, Bredero-Boelhouwer, HH, et al. Long-term functional outcome in 167 patients with syndromic craniosynostosis; defining a syndrome-specific risk profile. J Plast Reconstr Aesthet Surg. 2010;63(10):1635–41.Google Scholar
31.Scheid, SC, Spector, AR, Luft, JD. Tracheal cartilaginous sleeve in Crouzon syndrome. Int J Pediatr Otorhinolaryngol. 2002;65(2):147–52.CrossRefGoogle ScholarPubMed
32.Nargozian, C. Apert syndrome: anesthetic management. Clin Plast Surg. 1991;18(2):227–30.Google Scholar
33.Sculerati, N, Gottlieb, MD, Zimbler, MS, Chibbaro, PD, McCarthy, JG. Airway management in children with major craniofacial anomalies. Laryngoscope. 1998;108(12):1806–12.Google Scholar
34.Hayward, R, Gonsalez, S. How low can you go? Intracranial pressure, cerebral perfusion pressure, and respiratory obstruction in children with complex craniosynostosis. J Neurosurg. 2005;102(Suppl. 1):16–22.Google Scholar
35.Bristol, RE, Lekovic, GP, Rekate, HL. The effects of craniosynostosis on the brain with respect to intracranial pressure. Semin Pediatr Neurol. 2004;11(4):262–7.Google Scholar
36.Thompson, DN, Malcolm, GP, Jones, BM, Harkness, WJ, Hayward, RD. Intracranial pressure in single-suture craniosynostosis. Pediatr Neurosurg. 1995;22(5):235–40.Google Scholar
37.David, LR, Wilson, JA, Watson, NE, Argenta, LC. Cerebral perfusion defects secondary to simple craniosynostosis. J Craniofac Surg. 1996;7(3):177–85.Google Scholar
38.Czerwinski, M, Kolar, JC, Fearon, JA. Complex craniosynostosis. Plast Reconstr Surg. 2011;128(4):955–61.Google Scholar
39.Robson, CD, Mulliken, JB, Robertson, RL, et al. Prominent basal emissary foramina in syndromic craniosynostosis: correlation with phenotypic and molecular diagnoses. AJNR Am J Neuroradiol. 2000;21(9):1707–17.Google ScholarPubMed
40.Rich, PM, Cox, TC, Hayward, RD. The jugular foramen in complex and syndromic craniosynostosis and its relationship to raised intracranial pressure. AJNR Am J Neuroradiol. 2003;24(1):45–51.Google Scholar
41.Tuite, GF, Chong, WK, Evanson, J, et al. The effectiveness of papilledema as an indicator of raised intracranial pressure in children with craniosynostosis. Neurosurgery. 1996;38(2):272–8.Google Scholar
42.Jimenez, DF, Barone, CM, Cartwright, CC, Baker, L. Early management of craniosynostosis using endoscopic-assisted strip craniectomies and cranial orthotic molding therapy. Pediatrics. 2002;110(1 Pt 1):97–104.Google Scholar
43.Berry-Candelario, J, Ridgway, EB, Grondin, RT, Rogers, GF, Proctor, MR. Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment of craniosynostosis. Neurosurg Focus. 2011;31(2):E5.Google Scholar
44.Meier, PM, Goobie, SM, DiNardo, JA, et al. Endoscopic strip craniectomy in early infancy: the initial five years of anesthesia experience. Anesth Analg. 2011;112(2):407–14.Google Scholar
45.Tobias, JD, Johnson, JO, Jimenez, DF, Barone, CM, McBride, DS, Jr. Venous air embolism during endoscopic strip craniectomy for repair of craniosynostosis in infants. Anesthesiology. 2001;95(2):340–2.Google Scholar
46.Abbott, MM, Rogers, GF, Proctor, MR, Busa, K, Meara, JG. Cost of treating sagittal synostosis in the first year of life. J Craniofac Surg. 2012;23(1):88–93.Google Scholar
47.Lauritzen, CG, Davis, C, Ivarsson, A, Sanger, C, Hewitt, TD. The evolving role of springs in craniofacial surgery: the first 100 clinical cases. Plast Reconstr Surg. 2008;121(2):545–54.Google Scholar
48.Mackenzie, KA, Davis, C, Yang, A, MacFarlane, MR. Evolution of surgery for sagittal synostosis: the role of new technologies. J Craniofac Surg. 2009;20(1):129–33.Google Scholar
49.Ririe, DG, Smith, TE, Wood, BC, et al. Time-dependent perioperative anesthetic management and outcomes of the first 100 consecutive cases of spring-assisted surgery for sagittal craniosynostosis. Paediatr Anaesth. 2011;21:1015–19.Google Scholar
50.Windh, P, Davis, C, Sanger, C, Sahlin, P, Lauritzen, C. Spring-assisted cranioplasty vs pi-plasty for sagittal synostosis: a long term follow-up study. J Craniofac Surg. 2008;19(1):59–64.CrossRefGoogle ScholarPubMed
51.Faberowski, LW, Black, S, Mickle, JP. Blood loss and transfusion practice in the perioperative management of craniosynostosis repair. J Neurosurg Anesthesiol. 1999;11(3):167–72.Google Scholar
52.Meyer, P, Renier, D, Arnaud, E, et al. Blood loss during repair of craniosynostosis. Br J Anaesth. 1993;71(6):854–7.Google Scholar
53.Stricker, PA, Shaw, TL, Desouza, DG, et al. Blood loss, replacement, and associated morbidity in infants and children undergoing craniofacial surgery. Paediatr Anaesth. 2010;20(2):150–9.Google Scholar
54.Mirski, MA, Lele, AV, Fitzsimmons, L, Toung, TJ. Diagnosis and treatment of vascular air embolism. Anesthesiology. 2007;106(1):164–77.Google Scholar
55.Harris, MM, Yemen, TA, Davidson, A, et al. Venous embolism during craniectomy in supine infants. Anesthesiology. 1987;67(5):816–19.Google Scholar
56.Faberowski, LW, Black, S, Mickle, JP. Incidence of venous air embolism during craniectomy for craniosynostosis repair. Anesthesiology. 2000;92(1):20–3.Google Scholar
57.Meyer, PG, Renier, D, Orliaguet, G, Blanot, S, Carli, P. Venous air embolism in craniosynostosis surgery: what do we want to detect? Anesthesiology. 2000;93(4):1157–8.Google Scholar
58.Cucchiara, RF, Bowers, B. Air embolism in children undergoing suboccipital craniotomy. Anesthesiology. 1982;57(4):338–9.Google Scholar
59.Soriano, SG, McManus, ML, Sullivan, LJ, Scott, RM, Rockoff, MA. Doppler sensor placement during neurosurgical procedures for children in the prone position. J Neurosurg Anesthesiol. 1994;6(3):153–5.CrossRefGoogle ScholarPubMed
60.Clune, JE, Greene, AK, Guo, CY, et al. Perioperative corticosteroid reduces hospital stay after fronto-orbital advancement. J Craniofac Surg. 2010;21(2):344–8.Google Scholar
61.Zunini, GS, Rando, KA, Cox, RG. Fluid replacement in craniofacial pediatric surgery: normal saline or Ringer’s lactate? J Craniofac Surg. 2011;22(4):1370–4.CrossRefGoogle ScholarPubMed
62.Czerwinski, M, Hopper, RA, Gruss, J, Fearon, JA. Major morbidity and mortality rates in craniofacial surgery: an analysis of 8101 major procedures. Plast Reconstr Surg. 2010;126(1):181–6.Google Scholar
63.Bhananker, SM, Ramamoorthy, C, Geiduschek, JM, et al. Anesthesia-related cardiac arrest in children: update from the Pediatric Perioperative Cardiac Arrest Registry. Anesth Analg. 2007;105(2):344–50.Google Scholar
64.Cote, CJ, Liu, LM, Szyfelbein, SK, Goudsouzian, NG, Daniels, AL. Changes in serial platelet counts following massive blood transfusion in pediatric patients. Anesthesiology. 1985;62(2):197–201.CrossRefGoogle ScholarPubMed
65.Cote, CJ, Drop, LJ, Hoaglin, DC, Daniels, AL, Young, ET. Ionized hypocalcemia after fresh frozen plasma administration to thermally injured children: effects of infusion rate, duration, and treatment with calcium chloride. Anesth Analg. 1988;67(2):152–60.Google ScholarPubMed
66.Brown, KA, Bissonnette, B, McIntyre, B. Hyperkalaemia during rapid blood transfusion and hypovolaemic cardiac arrest in children. Can J Anaesth. 1990;37(7):747–54.CrossRefGoogle ScholarPubMed
67.Brown, KA, Bissonnette, B, MacDonald, M, Poon, AO. Hyperkalaemia during massive blood transfusion in paediatric craniofacial surgery. Can J Anaesth. 1990;37(4 Pt 1):401–8.Google Scholar
68.Flick, RP, Sprung, J, Harrison, TE, et al. Perioperative cardiac arrests in children between 1988 and 2005 at a tertiary referral center: a study of 92,881 patients. Anesthesiology. 2007;106(2):226–37.Google Scholar
69.Mattu, A, Brady, WJ, Robinson, DA. Electrocardiographic manifestations of hyperkalemia. Am J Emerg Med. 2000;18(6):721–9.Google Scholar
70.Weiskopf, RB, Schnapp, S, Rouine-Rapp, K, Bostrom, A, Toy, P. Extracellular potassium concentrations in red blood cell suspensions after irradiation and washing. Transfusion. 2005;45(8):1295–301.CrossRefGoogle ScholarPubMed
71.Swindell, CG, Barker, TA, McGuirk, SP, et al. Washing of irradiated red blood cells prevents hyperkalaemia during cardiopulmonary bypass in neonates and infants undergoing surgery for complex congenital heart disease. Eur J Cardiothorac Surg. 2007;31(4):659–64.Google Scholar
72.Fearon, JA, Weinthal, J. The use of recombinant erythropoietin in the reduction of blood transfusion rates in craniosynostosis repair in infants and children. Plast Reconstr Surg. 2002;109(7):2190–6.Google Scholar
73.Krajewski, K, Ashley, RK, Pung, N, et al. Successful blood conservation during craniosynostotic correction with dual therapy using procrit and cell saver. J Craniofac Surg. 2008;19(1):101–5.Google Scholar
74.Helfaer, MA, Carson, BS, James, CS, et al. Increased hematocrit and decreased transfusion requirements in children given erythropoietin before undergoing craniofacial surgery. J Neurosurg. 1998;88(4):704–8.CrossRefGoogle ScholarPubMed
75.Dadure, C, Sauter, M, Bringuier, S, et al. Intraoperative tranexamic acid reduces blood transfusion in children undergoing craniosynostosis surgery: a randomized double-blind study. Anesthesiology. 2011;114(4):856–61.CrossRefGoogle ScholarPubMed
76.Goobie, SM, Meier, PM, Pereira, LM, et al. Efficacy of tranexamic acid in pediatric craniosynostosis surgery: a double-blind, placebo-controlled trial. Anesthesiology. 2011;114(4):862–71.CrossRefGoogle ScholarPubMed
77.Di Rocco, C, Tamburrini, G, Pietrini, D. Blood sparing in craniosynostosis surgery. Semin Pediatr Neurol. 2004;11(4):278–87.Google Scholar
78.Phillips, RJ, Mulliken, JB. Venous air embolism during a craniofacial procedure. Plast Reconstr Surg. 1988;82(1):155–9.Google Scholar
79.Chang, JL, Albin, MS, Bunegin, L, Hung, TK. Analysis and comparison of venous air embolism detection methods. Neurosurgery. 1980;7(2):135–41.Google Scholar
80.Kvernmo, HD, Haugstvedt, JR. Treatment of congenital syndactyly of the fingers. Tidsskr Nor Laegeforen. 2013;133(15):1591–5.Google Scholar
81.Joseph-Reynolds, AM, Auden, SM, Sobczyzk, WL. Perioperative considerations in a newly described subtype of congenital long QT syndrome. Paediatr Anaesth. 1997;7(3):237–41.Google Scholar
82.Napolitano, C, Splawski, I, Timothy, KW, et al. GeneReviews® (Internet). Seattle, WA: University of Washington, Seattle; 1993–2017.Google Scholar
83.Khalid, S, Faizan, M, Alam, MM, et al. Congenital longitudinal radial deficiency in infants: spectrum of isolated cases to VACTERL syndrome. J Clin Neonatol. 2013;2(4):193–5.Google Scholar
84.Ashbaugh, H, Gellman, H. Congenital thumb deformities and associated syndromes. J Craniofac Surg. 2009;20(4):1039–44.Google Scholar
85.Gibstein, LA, Abramson, DL, Bartlett, RA, et al. Tissue expansion in children: a retrospective study of complications. Ann Plast Surg. 1997;38(4):358–64.Google Scholar
86.Bauer, BS, Few, JW, Chavez, CD, Galiano, RD. The role of tissue expansion in the management of large congenital pigmented nevi of the forehead in the pediatric patient. Plast Reconstr Surg. 2001;107(3):668–75.Google Scholar
87.Gosain, AK, Santoro, TD, Larson, DL, Gingrass, RP. Giant congenital nevi: a 20-year experience and an algorithm for their management. Plast Reconstr Surg. 2001;108(3):622–36.Google Scholar
88.Vaienti, L, Masetto, L, Davanzo, D, Marchesi, A, Ravasio, G. Giant congenital nevi of the scalp and forehead treated by skin expansion. Pediatr Med Chir. 2011;33(2):98–101.Google Scholar
89.Rasmussen, BS, Henriksen, TF, Kolle, SF, Schmidt, G. Giant congenital melanocytic nevus: report from 30 years of experience in a single department. Ann Plast Surg. 2013;74(2):223–9.Google Scholar
90.Clifton, MS, Heiss, KF, Keating, JJ, Mackay, G, Ricketts, RR. Use of tissue expanders in the repair of complex abdominal wall defects. J Pediatr Surg. 2011;46(2):372–7.Google Scholar
91.Mhamane, R, Dave, N, Garasia, M. Delayed primary repair of giant omphalocele: anesthesia challenges. Paediatr Anaesth. 2012;22(9):935–6.Google Scholar
92.Edwards, PD, Rahbar, R, Ferraro, NF, Burrows, PE, Mulliken, JB. Lymphatic malformation of the lingual base and oral floor. Plast Reconstr Surg. 2005;115(7):1906–15.Google Scholar
93.Tanaka, M, Sato, S, Naito, H, Nakayama, H. Anaesthetic management of a neonate with prenatally diagnosed cervical tumour and upper airway obstruction. Can J Anesth. 1994;41(3):236–40.Google Scholar
94.Bouchard, S, Johnson, MP, Flake, AW, et al. The EXIT procedure: experience and outcome in 31 cases. J Pediatr Surg. 2002;37(3):418–26.Google Scholar
95.Choleva, AJ. Anesthetic management of a patient undergoing an ex utero intrapartum treatment (EXIT) procedure: a case report. AANA J. 2011;79(6):497–503.Google Scholar
96.Lazar, DA, Olutoye, OO, Moise, KJ, Jr., et al. Ex-utero intrapartum treatment procedure for giant neck masses: fetal and maternal outcomes. J Pediatr Surg. 2011;46(5):817–22.Google Scholar
97.Farrell, PT. Prenatal diagnosis and intrapartum management of neck masses causing airway obstruction. Paediatr Anaesth. 2004;14(1):48–52.Google Scholar
98.Bryan, Y, Chwals, W, Ovassapian, A. Sedation and fiberoptic intubation of a neonate with a cystic hygroma. Acta Anaesthesiol Scand. 2005;49(1):122–3.Google Scholar
99.Burezq, H, Williams, B, Chitte, SA. Management of cystic hygromas: 30 year experience. J Craniofac Surg. 2006;17(4):815–18.Google Scholar
100.Boardman, SJ, Cochrane, LA, Roebuck, D, Elliott, MJ, Hartley, BE. Multimodality treatment of pediatric lymphatic malformations of the head and neck using surgery and sclerotherapy. Arch Otolaryngol Head Neck Surg. 2010;136(3):270–6.Google Scholar
101.Kim, SW, Kavanagh, K, Orbach, DB, et al. Long-term outcome of radiofrequency ablation for intraoral microcystic lymphatic malformation. Arch Otolaryngol Head Neck Surg. 2011;137(12):1247–50.Google Scholar
102.Balakrishnan, K, Menezes, MD, Chen, BS, Magit, AE, Perkins, JA. Primary surgery vs primary sclerotherapy for head and neck lymphatic malformations. JAMA Otolaryngol Head Neck Surg. 2014;140(1):41–5.Google Scholar

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