{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T05:47:31Z","timestamp":1793166451084,"version":"4.5.0"},"reference-count":25,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: This study aims to evaluate the adequacy of the liberal transfusion strategy applied in patients undergoing endoscopy-assisted Metopic, Coronal, or Sagittal craniosynostosis surgery according to the Pre-Transfusion and Post-Transfusion Estimated Red Blood Cell Mass (ERCM) ratios. Materials and Methods: This retrospective cohort study, conducted at the Pamukkale University Faculty of Medicine (2017\u20132023), utilized anesthesia, surgical records, and hospital electronic data of patients undergoing endoscopic craniosynostosis surgery. The primary endpoints were the rates of Post-Transfusion 1st-hour ERCM\/Pre-Transfusion ERCM (%) and Post-Transfusion 24th-hour ERCM\/Pre-Transfusion ERCM (%). The secondary endpoints were determined as Hemoglobin (Hb) and Hematocrit (Hct) values at the 1st and 24th hours after surgery, Calculated Blood Loss (CBL) during surgery (%), total 24 h CBL (%), ERCM (%), and Estimated Blood Loss (EBV) during surgery and total 24 h transfusions, Packed Red Blood Cells (PRBCs) (mL\/kg) amounts during surgery, and total 24 h transfusions. Results: A total of 86 pediatric craniosynostosis cases were evaluated and categorized into Metopic (n = 38), Sagittal (n = 33), and Coronal (n = 15) groups, with Post-Transfusion evaluation conducted across these groups. Post-Transfusion 1st-hour ERCM\/Pre-Transfusion ERCM ratios were found to have median values of 90.70% in the Metopic group, 91.61% in the Sagittal group, and 93.09% in the Coronal group. Post-Transfusion 24th-hour ERCM\/Pre-Transfusion ERCM ratios were found to be median values of 94.05% in the Metopic group, 88.3% in the Sagittal group, and 87.08% in the Coronal group. Conclusions: The liberal transfusion strategy provided adequate transfusion, maintaining ERCM ratios within the 85\u2013115% range across all groups. Significant decreases in Hb and Hct levels were observed from preoperative to postoperative measurements at 1 and 24 h. Changes in CBL, ERCM, EBV, and PRBC volumes were noted between the postoperative 1 h and 24 h measurements across all groups.<\/jats:p>","DOI":"10.3390\/medicina61040618","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T06:45:51Z","timestamp":1743144351000},"page":"618","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["An Evaluation of the Adequacy of the Liberal Transfusion Strategy in Endoscopy-Assisted Metopic, Coronal, or Sagittal Craniosynostosis Surgeries: A Retrospective Observational Study"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4768-3622","authenticated-orcid":false,"given":"Turan","family":"Evran","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Faculty of Medicine, Pamukkale University, Denizli 20160, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4930-4577","authenticated-orcid":false,"given":"Emrah","family":"Egemen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Pamukkale University, Denizli 20160, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bar\u0131\u015f","family":"Albuz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Pamukkale University, Denizli 20160, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130smet","family":"\u00c7opur","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Faculty of Medicine, Pamukkale University, Denizli 20160, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasim","family":"Asar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Pamukkale University, Denizli 20160, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asl\u0131 Mete","family":"Y\u0131ld\u0131z","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Faculty of Medicine, Pamukkale University, Denizli 20160, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seher","family":"\u0130lhan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Faculty of Medicine, Pamukkale University, Denizli 20160, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serkan","family":"Civlan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Pamukkale University, Denizli 20160, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00fclya","family":"Sungurtekin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Faculty of Medicine, Pamukkale University, Denizli 20160, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"key":"ref_1","first-page":"110","article-title":"CCraniosynostosis\u2014Recognition, clinical characteristics, and treatment","volume":"18","author":"Kajdic","year":"2018","journal-title":"Bosn. J. Basic Med. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1111\/j.1460-9592.2012.03927.x","article-title":"Anesthesia for surgery related to craniosynostosis: A review. Part 1","volume":"22","author":"Thomas","year":"2012","journal-title":"Paediatr. Anaesth."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.anclin.2020.06.004","article-title":"Anesthesia for Innovative Pediatric Surgical Procedures","volume":"38","author":"Lee","year":"2020","journal-title":"Anesthesiol. Clin."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1177\/10556656221085478","article-title":"Open Versus Minimally Invasive Approach for Craniosynostosis: Analysis of the National Surgical Quality Improvement Program-Pediatric","volume":"60","author":"Rizvi","year":"2023","journal-title":"Cleft Palate Craniofacial J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e593","DOI":"10.1016\/j.wneu.2023.02.102","article-title":"Circulating Brain-Injury Markers After Surgery for Craniosynostosis","volume":"173","author":"Skoglund","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/j.1460-9592.2012.03922.x","article-title":"Anesthesia for surgery related to craniosynostosis: A review. Part 2","volume":"23","author":"Hughes","year":"2013","journal-title":"Paediatr. Anaesth."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1097\/SCS.0b013e31825bd02a","article-title":"Blood loss estimation during fronto-orbital advancement: Implications for blood transfusion practice and hospital length of stay","volume":"23","author":"Seruya","year":"2012","journal-title":"J. Craniofacial Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1056\/NEJMoa066240","article-title":"Transfusion strategies for patients in pediatric intensive care units","volume":"356","author":"Lacroix","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/EJA.0000000000001803","article-title":"Management of severe perioperative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care: Second update 2022","volume":"40","author":"Kietaibl","year":"2023","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1007\/s10143-024-02785-3","article-title":"Red blood cell transfusion threshold guidelines in pediatric neurosurgery","volume":"47","author":"Azam","year":"2024","journal-title":"Neurosurg. 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Anaesth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1007\/BF03005352","article-title":"Craniosynostosis: An assessment of blood loss and transfusion practices","volume":"36","author":"Kearney","year":"1989","journal-title":"Can. J. Anaesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/s003810050230","article-title":"Perioperative specific management of blood volume loss in craniosynostosis surgery","volume":"14","author":"Kang","year":"1998","journal-title":"Childs Nerv. Syst."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e2112","DOI":"10.1097\/GOX.0000000000002112","article-title":"Calculated Blood Loss and Transfusion Requirements in Primary Open Repair of Craniosynostosis","volume":"7","author":"Lopez","year":"2019","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1097\/SCS.0000000000010165","article-title":"A Transfusion Regimen With Same-donor Packed Red Blood Cells Reduces Exposure to Multiple Blood Donors in Craniosynostosis Surgery","volume":"35","author":"Uslu","year":"2024","journal-title":"J. Craniofacial Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"412","DOI":"10.3171\/2021.10.PEDS21438","article-title":"Importance of tranexamic acid in pediatric monosutural craniosynostosis surgery","volume":"29","author":"Eustache","year":"2021","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e29093","DOI":"10.1002\/pbc.29093","article-title":"\u03b5-Aminocaproic acid versus tranexamic acid in children undergoing complex cranial vault reconstruction for repair of craniosynostosis","volume":"68","author":"Borst","year":"2021","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1213\/ANE.0b013e31820471e4","article-title":"Endoscopic strip craniectomy in early infancy: The initial five years of anesthesia experience","volume":"112","author":"Meier","year":"2011","journal-title":"Anesth. Analg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"361","DOI":"10.3171\/2015.7.PEDS15187","article-title":"Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution","volume":"17","author":"Han","year":"2016","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1007\/s00404-017-4506-6","article-title":"Major underestimation and overestimation of visual blood loss during cesarean deliveries: Can they be predicted?","volume":"296","author":"Gluck","year":"2017","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1111\/j.1460-9592.2011.03689.x","article-title":"Factors influencing blood loss and allogeneic blood transfusion practice in craniosynostosis surgery","volume":"21","author":"Megens","year":"2011","journal-title":"Paediatr. Anaesth."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1007\/s00381-021-05429-9","article-title":"Modified endoscopic strip craniectomy technique for sagittal craniosynostosis: Provides comparable results and avoids bony defects","volume":"38","author":"Sakar","year":"2022","journal-title":"Childs Nerv. Syst."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1097\/SCS.0000000000008378","article-title":"Antifibrinolytics Are Not Associated With Reduced Blood Loss in Minimally-Invasive Endoscopic-Assisted Craniectomy for Repair of Single-Suture Craniosynostosis","volume":"33","author":"Sobey","year":"2022","journal-title":"J. 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