Background: Craniosynostosis, the premature fusion of cranial sutures, poses significant anesthetic challenges due to associated craniofacial abnormalities, potential airway difficulties, and risks of substantial intraoperative blood loss. This case report presents the perioperative anesthetic management of a pediatric patient with sagittal craniosynostosis undergoing calvarial reconstruction with fronto-orbital advancement.

Case Description: A two-year-nine-month-old male with microcephaly, developmental delay, and seizure disorder presented for craniosynostosis correction. Preoperative imaging confirmed sagittal suture fusion with associated cerebral atrophy. Anticipated difficulties included a difficult airway, hypothermia, and major blood loss. Airway management was successfully achieved using a video laryngoscope and a 4 mm ID RAE tube. Intraoperatively, blood loss was managed with transfusion of PRBCs and FFP, aided by prophylactic tranexamic acid and vigilant hemodynamic monitoring. Temperature control was maintained using active warming strategies. Postoperatively, the patient required elective mechanical ventilation and titrated opioid analgesia, followed by successful extubation in the ICU.

Conclusion: This case emphasizes the need for individualized, multidisciplinary perioperative strategies in pediatric craniosynostosis repair. Proactive airway planning, blood conservation, normothermia maintenance, and tailored postoperative care are vital for optimizing outcomes and minimizing complications.

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