Perioperative anaesthetic practice for head and neck free tissue transfer - a UK national survey

Gooneratne, Hasanthi; Lalabekyan, Bagrat; Clarke, S.; Burdett, Edward

doi:10.1111/aas.12180

Cited by 26 publications

(22 citation statements)

References 42 publications

(53 reference statements)

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“…56 Despite these findings, in a recent survey of anesthesiologists, 25% preferred crystalloid as first line for blood pressure management, 39% preferred colloid as first line, and 46% reported a positive balance of 2 to 5 L as acceptable. 57 Norepinephrine was considered contraindicated by 46% of respondents. 57 Pain management is important as it reduces circulating catecholamines, which may contribute to vasospasm and vasoconstriction.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative Management for Microsurgical Free Tissue Transfer: Survey of Current Practices with a Comparison to the Literature

Motakef

Mountziaris

Ismail

et al. 2015

J reconstr Microsurg

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Current practices remain exceedingly diverse and at times differ from best practices, which may be identified from the available literature. Key areas where patient care can be standardized and optimized include anesthesia, patient temperature, fluid management, the use of vasoactive agents, and analgesic medications. Standardized, evidence-based guidelines have the potential to further improve patient care and free flap outcomes.

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Section: Discussionmentioning

confidence: 99%

“…57 Norepinephrine was considered contraindicated by 46% of respondents. 57 Pain management is important as it reduces circulating catecholamines, which may contribute to vasospasm and vasoconstriction. A single preoperative dose of gabapentin may reduce postoperative analgesic and antiemetic use.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Management for Microsurgical Free Tissue Transfer: Survey of Current Practices with a Comparison to the Literature

Motakef

Mountziaris

Ismail

et al. 2015

J reconstr Microsurg

View full text Add to dashboard Cite

show abstract

“…6 Even among anesthesiologists, norepinephrine use in free flap surgery was deemed contraindicated by 46%. 7 To date, there is insufficient prospective clinical evidence which supports the absolute contraindication of vasopressor administration during free flap surgery. 8 The results from animal studies have been contradictory, with some authors demonstrating impairment of pedicle flow and flap microcirculation with vasopressor use 9,10 while others have observed either no effect or even an increase in blood flow to the flap.…”

mentioning

confidence: 99%

Perioperative Vasopressor Use in Free Flap Surgery: A Systematic Review and Meta-Analysis

Goh

Song

et al. 2019

J reconstr Microsurg

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Background The use of vasopressors in free flap surgery has traditionally been avoided due to the presumed risk of pedicle vasospasm leading to flap failure. However, there is a lack of strong clinical evidence to suggest that their administration during microvascular surgery is absolutely contraindicated. The aim of this study is to clarify the impact of perioperative vasopressor use on free flap outcomes. Methods A systematic review was performed of all English-language articles that have compared free flap outcomes between patients who received vasopressors and those who did not. The outcome measures were total flap failure, pedicle thrombosis, and overall flap complications. Meta-analysis was performed using Mantel–Haenszel fixed-effects and DerSimonian and Laird random-effects models. Results From a total of 130 citations, 14 studies representing 8,653 cases were analyzed. Majority of these did not find any negative effects of vasopressor use irrespective of dose, timing of administration, and method of delivery. Meta-analysis demonstrated that vasopressors were associated with less total flap failure overall (odds ratio, [OR]: 0.71, p = 0.05) and less pedicle thrombosis in head and neck reconstruction specifically (OR: 0.58, p = 0.02). Flap complication rates were similar across all defect types (OR: 0.97, p = 0.81) but appeared to be increased in breast reconstruction (OR: 1.46, p = 0.01). Conclusion Perioperative vasopressor administration does not appear to be as detrimental to free flap survival as has been previously feared. Their role in optimizing hemodynamic stability may have a more beneficial effect on overall flap perfusion and in minimizing the complications of iatrogenic fluid overload.

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“…15 The need for this analysis was further evidenced by the varied anesthetic management of patients undergoing free flap surgery, suggesting a paucity of data with which to construct evidence-based guidelines. 16,17 Anesthesia duration represents a modifiable risk factor, and the identification of significant associations may help guide patient selection and intraoperative decision making. This study aimed to elucidate possible associations between anesthesia duration, preoperative characteristics, and postoperative complications in patients undergoing head and neck free flap surgery by using population-based data collected from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.…”

mentioning

confidence: 99%

Association of Anesthesia Duration With Complications After Microvascular Reconstruction of the Head and Neck

Brady

Desai

Crippen

et al. 2018

JAMA Facial Plast Surg

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IMPORTANCE Prolonged anesthesia and operative times have deleterious effects on surgical outcomes in a variety of procedures. However, data regarding the influence of anesthesia duration on microvascular reconstruction of the head and neck are lacking.OBJECTIVE To examine the association of anesthesia duration with complications after microvascular reconstruction of the head and neck. DESIGN, SETTING, AND PARTICIPANTS The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to collect data. In total, 630 patients who underwent head and neck microvascular reconstruction were recorded in the NSQIP registry from January 1, 2005, through December 31, 2013. Patients who underwent microvascular reconstructive surgery performed by otolaryngologists or plastic surgeons were included in this study. Data analysis was performed from October 15, 2015, to January 15, 2016. EXPOSURES Microvascular reconstructive surgery of the head and neck. MAIN OUTCOMES AND MEASURES Patients were stratified into 5 quintiles based on mean anesthesia duration and analyzed for patient characteristics and operative variables (mean [SD] anesthesia time: group 1, 358.1 [175.6] minutes; group 2, 563.2 [27.3] minutes; group 3, 648.9 [24.0] minutes; group 4, 736.5 [26.3] minutes; and group 5, 922.1 [128.1] minutes). Main outcomes include rates of postoperative medical and surgical complications and mortality. RESULTS A total of 630 patients undergoing head and neck free flap surgery had available data on anesthesia duration and were included (mean [SD] age, 61.6 [13.8] years; 436 [69.3%] male). Bivariate analysis revealed that increasing anesthesia duration was associated with increased 30-day complications overall (55 [43.7%] in group 1 vs 80 [63.5%] in group 5, P = .006), increased 30-day postoperative surgical complications overall (45 [35.7%] in group 1 vs 78 [61.9%] in group 5, P < .001), increased rates of postoperative transfusion (32 [25.4%] in group 1 vs 70 [55.6%] in group 5, P < .001), and increased rates of wound disruption (0 in group 1 vs 10 [7.9%] in group 5, P = .02). No specific medical complications and no overall medical complication rate (24 [19.0%] in group 1 vs 22 [17.5%] in group 5, P = .80) or mortality (1 [0.8%] in group 1 vs 1 [0.8%] in group 5, P = .75) were associated with increased anesthesia duration. On multivariate analysis accounting for demographics and significant preoperative factors including free flap type, overall complications (group 5: odds ratio [OR], 1.98; 95% CI, 1.10-3.58; P = .02), surgical complications (group 5: OR, 2.46; 95% CI, 1.35-4.46; P = .003), and postoperative transfusion (group 5: OR, 2.31; 95% CI, 1.27-4.20; P = .006) remained significantly associated with increased anesthesia duration; the association of wound disruption and increased anasthesia duration was nonsignificant (group 5: OR, 2.0; 95% CI, 0.75-5.31; P = .16). CONCLUSIONS AND RELEVANCEIncreasing anesthesia duration was associated with significantly increased rates of surgical complic...

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Perioperative anaesthetic practice for head and neck free tissue transfer - a UK national survey

Abstract: Currently in the UK, anaesthetic perioperative management for head and neck free flap transfer is varied, reflecting the paucity of high-quality data in this area; but some techniques, in particular avoidance of excessive crystalloid use, is associated with improved flap outcome.

Cited by 26 publications

References 42 publications

Perioperative Management for Microsurgical Free Tissue Transfer: Survey of Current Practices with a Comparison to the Literature

Perioperative Management for Microsurgical Free Tissue Transfer: Survey of Current Practices with a Comparison to the Literature

Perioperative Vasopressor Use in Free Flap Surgery: A Systematic Review and Meta-Analysis

Association of Anesthesia Duration With Complications After Microvascular Reconstruction of the Head and Neck

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