Anaesthesia for reconstructive surgery

Quinlan, Jane; Lodi, Omer

doi:10.1016/j.mpaic.2008.11.008

Cited by 15 publications

(9 citation statements)

References 2 publications

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“…Anaesthetic management in free flap surgery has been described in the literature [ 1 , 2 , 7 , 8 ]. A series of principles such as maintenance of a high cardiac output, systolic pressure >100 mmHg, low systemic vascular resistance, normothermia, high urine output and effective analgesia, together with a mild haemodilution to a haematocrit value of 30–35%, results in compromise.…”

Section: Discussionmentioning

confidence: 99%

“…A series of principles such as maintenance of a high cardiac output, systolic pressure >100 mmHg, low systemic vascular resistance, normothermia, high urine output and effective analgesia, together with a mild haemodilution to a haematocrit value of 30–35%, results in compromise. These are usually obtained by the use of a deliberate fluid management [ 1 , 7 - 10 ]. These studies also advocate not using vasoactive agents due to either the increase in systemic vascular resistance or decrease in cardiac output.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative fluid overload increases anastomosis thrombosis in the free TRAM flap used for breast reconstruction

Booi

2010

Eur J Plast Surg

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To increase perfusion pressure with vasoactive drugs may be in conflict with the opinion of the reconstructive surgeon who maintains that the systemic administration of vasoactive agents causes vasoconstriction of the pedicle artery and the microvasculature. In free flap surgery, deliberate fluid therapy is used with a minimum of vasoactive drugs. This retrospective study was performed to analyse the perioperative fluid therapy, its effect on hemodynamic parameters and on the outcome of free flap surgery. One hundred and four patients were included in this retrospective study. The muscle sparing free transverse rectus abdominis myocutaneous flap was used for breast reconstruction. Perioperative hemodynamic data was used for this study. Twenty-seven patients had one or two complications requiring return to the operating room (OR). Two cases returned to the OR because of postoperative bleeding; in 11 patients, the anastomosis was revised. The reason for surgery in the latter group was venous stasis, due to thrombus formation at the venous anastomosis. The volume of fluid therapy was significantly higher in patients who returned to the OR due to thrombus formation at the anastomosis. Based on the results of this study, restricted intravenous fluid therapy or guided fluid therapy is recommended. Invasive monitoring such as central venous pressure and invasive arterial monitoring is recommended. Fluid loss should be replaced, and fluid overload should be avoided when the breast is reconstructed using free-tissue transfers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perioperative fluid overload increases anastomosis thrombosis in the free TRAM flap used for breast reconstruction

Booi

2010

Eur J Plast Surg

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“…Several researchers have recommended maintaining systolic arterial pressure more than 100 mmHg. 3,7 However, in our experience, a systolic arterial pressure not less than 90 mmHg seems safe for DIEP flaps. The rates of flap thrombosis and flap failure in our series were within the range of reported large series from known experts.…”

Section: Discussionmentioning

confidence: 64%

“…5,6 Other theoretical advantages of epidural anesthesia include a reduction in perioperative blood loss and vessel spasm, a lower incidence of deep vein thrombosis, improved diaphragmatic function, and more rapid postoperative recovery. [7][8][9] There have been no reports on the safety, benefits, and adverse effects of epidural anesthesia/general anesthesia combination in patients undergoing free flap breast reconstruction. Therefore, the objective of this study was to compare postoperative pain, side effects, intraoperative hemodynamics, and flap perfusion in abdominally based free flap breast reconstruction under general anesthesia alone versus epidural anesthesia/general anesthesia combination.…”

mentioning

confidence: 99%

Epidural Combined with General Anesthesia versus General Anesthesia Alone in Patients Undergoing Free Flap Breast Reconstruction

Feifei

Sun

Huang

et al. 2016

Plastic and Reconstructive Surgery

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“…Secondary ischemia can occur following attachment, after a free flap has been transferred and reperfused. Risk of secondary ischemia can be minimised by optimal anaesthetic technique and appropriate fluid therapy (Quinlan and Lodi, 2009).…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting the Risk of Free Flap Failure in Microvascular Surgery

Stepanovs

Ozoliņa

Rovīte

et al. 2016

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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Microvascular free flap surgery, has become an important part of reconstructive surgery during the last decades, as it allows closure of various tissue defects and recovery of organs function. Despite surgical progress resulting in high rates of transferred tissue survival, the risk of pedicle vessels thrombosis still remains a significant problem. A total of 108 articles from Pubmed and Science Direct databases published in 2005–2015 were analysed. This review of the literature assessed the influence of patient-dependent risk factors and different perioperative management strategies on development of microvascular free flap thrombosis. Sufficient evidence for risk associated with hypercoagulation, advanced age and certain comorbidities was identified. Presently, rotational thromboelastometry allows early hypercoagulability detection, significantly changing further patient management. Identification of flap thrombosis promoting surgery-related aspects is also essential in preoperative settings. Choice of anaesthesia and postoperative analgesia, administration of different types and amounts of fluids, blood products and vasoactive agents, temperature control are no less important in perioperative anaesthesiological management. More attention should be focused on timely preoperative evaluation of patient-dependent risk factors, which can influence anaesthesiological and surgical tactics during and after microvascular free flap surgery. Perioperative anaesthesiological management strategy continues to be controversial and therefore it should be performed based on thrombotic risk assessment and patient individual needs, thus improving flap survival rates and surgical outcome.

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Anaesthesia for reconstructive surgery

Cited by 15 publications

References 2 publications

Perioperative fluid overload increases anastomosis thrombosis in the free TRAM flap used for breast reconstruction

Perioperative fluid overload increases anastomosis thrombosis in the free TRAM flap used for breast reconstruction

Epidural Combined with General Anesthesia versus General Anesthesia Alone in Patients Undergoing Free Flap Breast Reconstruction

Factors Affecting the Risk of Free Flap Failure in Microvascular Surgery

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