Epinephrine, Norepinephrine, Dobutamine, and Dopexamine Effects on Free Flap Skin Blood Flow

Eley, Karen A.; Young, J D; Watt-Smith, Stephen R.

doi:10.1097/prs.0b013e31825dbf73

Cited by 75 publications

(66 citation statements)

References 5 publications

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“…36,37 Prospective studies comparing epinephrine, norepinephrine, dobutamine, and dopexamine postoperatively demonstrated that both dobutamine and norepinephrine improved free flap skin blood flow, with norepinephrine yielding the greatest improvement. 34,35 In contrast, dopexamine and epinephrine decreased flap flow. 34…”

Section: Vasopressorsmentioning

confidence: 96%

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

Motakef

Mountziaris

Ismail

et al. 2015

Plastic and Reconstructive Surgery

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Current practices remain exceedingly diverse. Key strategies to improve patient outcomes can be defined from the available literature. Key evidence-based guidelines included that normothermia should be maintained perioperatively to improve outcomes (level of evidence 2b), and volume replacement should be maintained between 3.5 and 6.0 ml/kg per hour (level of evidence 2b). Vasopressors do not harm outcomes and may improve flap flow (level of evidence 1b), with most evidence supporting the use of norepinephrine over other vasopressors (level of evidence 1b). Dextran should be avoided (level of evidence 1b), and pump systems for local anesthetic infusion are beneficial following free flap breast reconstruction (level of evidence 1b). Further prospective studies will improve the quality of available evidence.

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Section: Vasopressorsmentioning

confidence: 96%

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

Motakef

Mountziaris

Ismail

et al. 2015

Plastic and Reconstructive Surgery

View full text Add to dashboard Cite

show abstract

“…This study showed that both dobutamine and norepinephrine had beneficial effects on flap skin blood flow, and that the maximal improvement in flow occurred with norepinephrine (Level V Evidence). 137 Dobutamine had little vasoconstrictive effect, increasing flow in the flap and control without changing blood pressure. The vasospastic effects of norepinephrine were overcome by the rise in blood pressure up to a dose of 0.15 μg/kg/ minute optimal pressor to use in patients with hypotension after free flap surgery.…”

Section: Anesthetic Considerationsmentioning

confidence: 96%

Evidence to Support Controversy in Microsurgery

Fan

Patel

Mardini

et al. 2015

Plastic and Reconstructive Surgery

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Microsurgery practice, including preoperative patient selection, intraoperative technique, and anesthetic considerations, varies from institution to institution and from surgeon to surgeon. Many surgeons' practices are driven by "conventional wisdom," which is handed down from mentors to fellows and residents. In this article, the authors explore the oxymoron that there is evidence to support controversy in microsurgery. Indeed, if there was convincing evidence to support varying microsurgery practices, there would be no controversy. The authors conducted a review with a focus on evidence-based medicine to support microsurgery practice.

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“…The thought is that an attenuated pressor response occurs after surgical sympathectomy, which occurs during vessel dissection [29]. Dobutamine was found to improve flap flow and both dobutamine and norepinephrine improved free flap skin blood flow [30]. Phenylephrine and epinephrine both decreased flap flow [31].…”

Section: Special Considerations Vasoactive Medicationsmentioning

confidence: 99%

Flap-based breast reconstructions

Bartlett

Kołacińska

Spiegel

2017

Nowotwory. Journal of Oncology

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Breast cancer reconstruction is generally broken down into two major categories: Implant based and autologous. Both can provide excellent aesthetic results in the well selected patient although the decision ultimately comes down to the patient under the guidance of a reconstructive plastic surgeon. Implant based reconstruction is beyond the scope of this text, rather we will discuss autologous based reconstructive options. Broadly classified, tissue based reconstruction can be categorized as local or free tissue transfer. The general theme is the use of excess or expendable tissue in order to reconstruct breast defects. Studies have shown women are more satisfied with autologous based reconstruction compared to implanted based [1]. In this chapter we will discuss different tissue flap options in the reconstructive plastic surgeons armamentarium, special considerations and how it relates to the oncologic breast surgeon.

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Epinephrine, Norepinephrine, Dobutamine, and Dopexamine Effects on Free Flap Skin Blood Flow

Abstract: Both dobutamine and norepinephrine had beneficial effects on flap skin blood flow. The maximal improvement in flow occurred with norepinephrine, making it the optimal pressor to use in patients with hypotension after free flap surgery.

Cited by 75 publications

References 5 publications

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

Evidence to Support Controversy in Microsurgery

Flap-based breast reconstructions

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