Premium
Comparison of different dosage regimes of epsilon aminocaproic acid on blood loss in children undergoing craniosynostosis surgery
Author(s) -
Nguyen Thanh T.,
Lam Humphrey V.,
Austin Thomas M.,
Stricker Paul,
Tunceroglu Huseyin,
Schoenecker Jonathan
Publication year - 2019
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.13671
Subject(s) - medicine , craniosynostosis , epsilon aminocaproic acid , blood loss , surgery , anesthesia
Background Open cranial vault reconstruction is frequently performed for craniosynostosis. These procedures often involve high volume blood loss that requires blood transfusion. Antifibrinolytics have been shown to decrease blood loss during these procedures but the optimal dose that maximizes benefits is not known. Aims The primary aim was to evaluate the differences in calculated blood loss between a high infusion rate (40 mg/kg/h) and a low infusion rate (≤30 mg/kg/h) of epsilon aminocaproic acid after a 100 mg/kg loading dose. Secondary aims were to determine if a high infusion rate of epsilon aminocaproic acid was associated with decreased packed red cell transfusion volume and to determine the factors associated with blood loss. Methods This was a retrospective study of children who underwent open cranial vault reconstruction. Using an electronic medical record, we identified patients that fit the inclusion criteria. Demographic, laboratory, transfusion, and perioperative data were collected and statistical analysis was performed. Results Fifty‐three patients were included into the study with twenty‐three receiving higher infusion rate (40 mg/kg/h) epsilon aminocaproic acid. There was a 14.3 mL/kg (95% CI 6.6‐23.9) decrease in calculated blood loss in the high‐dose cohort. Conclusion An EACA bolus of 100 mg/kg followed by an infusion of 40 mg/kg was associated with a lower calculated blood loss compared to the group who received 100 mg/kg EACA and ≤ 30 mg/kg infusion.