Recovery After Surgery for Syndromic Craniosynostosis in Children

Postoperative Orders 

• Initial care in PICU or high dependency unit: Most children do not require ventilation postoperatively, but the facility to do so should be available if required.
• Routine observation: Routine observation and care are the same as for any major craniotomy. ICP monitoring is not routinely performed.
• Analgesia: In the initial 24–48 hours analgesia is normally achieved with morphine infusion titrated against level of consciousness. After 24 hours non-steroidal analgesics can be given as the morphine infusion is gradually reduced and withdrawn.
• Hematocrit, clotting profile, and serum electrolytes: Clotting is normally corrected during the operation but should be checked and, if necessary, corrected in the immediate postoperative phase. Hemoglobin and sodium levels should be carefully monitored, at least every 6 hours during the first postoperative 48 hours, and corrected if required.

Postoperative Morbidity

• Pain: Pain usually resolves over the initial 72–96 hours after surgery.
• Facial soft-tissue swelling: Facial soft-tissue swelling gradually develops over the first 48 hours and peaks around 96 hours after surgery before it begins to resolve. The eyes usually close during this period. Most patients are well enough to be discharged 5 or 6 days after surgery, once their eyes have opened.