Reconstituted blood reduces blood donor exposures in children undergoing craniofacial reconstruction surgery.

OBJECTIVE/AIMS: To assess the effect of prophylactic administration of fresh-frozen plasma (FFP) in the form of reconstituted blood in children undergoing craniofacial reconstruction. The outcomes of interest included immediate postoperative coagulation laboratory test results, postoperative surgical drain output, and the number of unique blood donor exposures incurred. BACKGROUND: We recently changed our intraoperative transfusion strategy in children undergoing craniofacial reconstruction surgery to one in which blood loss is replaced with donor-matched reconstituted blood rather than traditional blood component therapy. METHODS: We performed a query of our prospective craniofacial surgery perioperative registry for children who underwent fronto-orbital advancement or posterior cranial vault reconstruction. Registry data from this query were compared to data from a historical cohort. RESULTS: Data for 46 registry cases were compared to 150 historical cohort cases. The median number of unique donor exposures for the reconstituted blood group was 2 vs 3 in the historical cohort (P=0.004). The reconstituted blood group had a decreased incidence of postoperative derangements in soluble clotting factor tests (fibrinogen, PT, or aPTT; 2% vs 24%, P=0.001), while there was no evidence for a difference in the incidence of thrombocytopenia. There was no evidence for differences in postoperative surgical drain output in the reconstituted blood group and historical cohort over the first 12, 24, and 48 h. CONCLUSIONS: Prophylactic administration of FFP in the form of donor-matched reconstituted blood in children undergoing craniofacial reconstruction was associated with improved postoperative coagulation parameters, reduced blood donor exposures, and unchanged postoperative surgical drain output.

Bradycardia during induction of anesthesia with sevoflurane in children with Down syndrome.

BACKGROUND: Bradycardia is a complication associated with inhaled induction of anesthesia with halothane in children with Down syndrome. Although bradycardia has been reported after anesthetic induction with sevoflurane in these children, the incidence is unknown. OBJECTIVES: In this study we compared the incidence and characteristics of bradycardia after induction of anesthesia with sevoflurane in children with Down syndrome to healthy controls. METHODS: We reviewed electronic anesthetic records of 209 children with Down syndrome and 268 healthy control patients who had inhaled induction of anesthesia with sevoflurane over an 8-year period. Data extracted from the medical record included demographics, history of congenital heart disease, heart rate, oxyhemoglobin saturation, expired sevoflurane concentrations, arterial blood pressure, and any treatment of bradycardia during the first 360 seconds after the start of induction of anesthesia. Bradycardia and hypotension were defined as heart rate and arterial blood pressure below the critical limits recommended for activating a pediatric rapid response team to the bedside of a hospitalized child for quick intervention. Factors associated with bradycardia were identified in a univariate analysis. A step-wise backward multiple logistic regression model was used to identify independent factors. Differences between the 2 groups were computed using Fisher's exact test or χ(2) tests for categorical data and t tests for continuous data. RESULTS: Univariate analysis demonstrated that Down syndrome, low ASA physical status, congenital heart disease, and mean sevoflurane concentrations were factors associated with bradycardia. However, multivariate analysis showed that only Down syndrome and low ASA physical status remained as independent factors associated with bradycardia. CONCLUSION: Bradycardia during anesthetic induction with sevoflurane was common in children with Down syndrome, with and without a history of congenital heart disease.

Effect of liquid rubber additions on physical properties of Bis-GMA based dental resins.

OBJECTIVE: The aim of this investigation was to determine the effect of an experimental liquid rubber (LR) toughening agent on fracture toughness, crosslink density and Barcol hardness of polymerized mixtures of 50/50 wt% Bis-GMA and TEGDMA. METHODS: An experimental LR, was added to a solution of Bis-GMA and TEGDMA containing 1wt% dimethylamino ethyl methacrylate and 0.5 wt% camphoroquinone at concentrations 0-10%. The composites were polymerized by exposure to a visible light curing unit for 60s. Fracture toughness was determined according to ASTM. 399. Crosslink density was evaluated using a swell test in ethanol. RESULTS: Mean fracture toughness values ranged from 0.39 MPa m(1/2) for samples containing 6% to 1.24 MPa m(1/2) for samples containing 8% LR. Fracture toughness of samples containing 2%, 4%, and 8% LR were significantly higher than controls. The highest degree of cross-linkage was obtained in controls and lowest for samples containing 2% LR. Barcol Hardness values ranged from 36.7 for the control and 4% LR composition to 31.2 for samples containing 10% LR. SIGNIFICANCE: Addition of 2, 4 and 8% LR increases the fracture toughness of Bis-GMA/TEGDMA composites. Addition of LR shows promise as a method of improving the fracture toughness of Bis-GMA based dental composites.