Efficacy of Tranexamic Acid in Craniosynostosis Repair in an Infant

Abstract

Introduction Extensive blood loss is common in pediatric craniosynostosis reconstruction surgery and so are transfusion-related morbidity and mortality. Tranexamic acid is an antifibrinolytic agent and is increasingly being used in children to reduce perioperative blood loss in various settings, including during craniosynostosis surgery. Case Report An 8-month-old, 9-kg male infant was admitted to our hospital for craniosynostosis repair. The operation was performed under a balanced general anesthesia. Two central lines and one peripheral line were cannulated in case of a need of massive transfusion. Invasive monitoring was used, as well as prevention of hypothermia. As massive blood loss was expected, before beginning the surgery bolus of tranexamic acid as well as packed red blood cells was administered. During the operation, tranexamic acid was given continuously in an intravenous infusion. The child was hemodynamically stable throughout the operation. After the completion of surgery, which lasted for 5 hours, the patient was extubated in the operating room. Postoperatively, the patient was admitted to the intensive care unit, where he stayed for 24 hours. Hemoglobin values were stable, and there was no need for additional blood replacement. Conclusion Extensive blood loss is common in pediatric craniosynostosis reconstruction surgery, transfusion being unavoidable in the majority of cases. In our patient, tranexamic acid proved effective in reducing perioperative blood loss and transfusion requirement.