The effect of dobutamine on blood flow of free tissue transfer flaps during head and neck reconstructive surgery*

Abstract

Summary In view of the controversy over the use of inotropes in free tissue transfer surgery, we assessed the effect of different intra‐operative dobutamine infusion rates on blood flow in the anastomosed recipient artery. Twenty patients undergoing head and neck tumour resection and immediate reconstructive surgery with free tissue transfer were recruited. After completion of the microvascular anastomoses, patients received dobutamine infusions of 2, 4 and 6 μg.kg−1.min−1 in a randomised order. After steady state dobutamine concentration was achieved, mean and maximum blood flow in the arterial anastomosis was measured at each concentration, using the Medi‐Stim Butterfly Flowmeter system. Systemic haemodynamic parameters were simultaneously recorded using a pulse contour cardiac output system. Both mean and maximum blood flow increased significantly in the anastomosed artery at dobutamine infusions of 4 and 6 μg.kg−1.min−1 and this was accompanied by increased cardiac output. This may improve free flap perfusion.

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

“…29,33 Dobutamine has been shown to significantly improve flap flow. 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.…”

Evidence to Support Controversy in Microsurgery

“…Using an ultrasonic transit time flow meter, an increase in mean and maximum blood flow with increased cardiac output was found after infusion of dobutamine in head and neck flaps (Level V Evidence). 133 Although intraoperative use of amrinone had no effect (Level V Evidence), 134 studies reported that use of phenylephrine in pig models are equivocal (Level V Evidence). 135,136 A recent prospective study examined flowthrough skin flap monitoring by laser Doppler velocimetry.…”

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

“…As a result, many surgeons remain wary of using such agents. 4 The best agent to maintain blood pressure without adverse effect on flap blood flow remains unclear. This study investigated the effects on flap skin perfusion of four common sympathomimetic agents routinely used in intensive care practice.…”

“…There is only one study of total blood flow to free flaps in human subjects. Scholz et al 4 investigated the effect of dobutamine on total blood flow of free tissue transfer flaps during head and neck surgery. After completion of the anastomoses, the flow in the anastomosed donor artery was measured with an ultrasonic flow meter.…”