Background The role of vasopressors has long been a subject of debate in microsurgery. Conventional wisdom dictates the avoidance of vasopressor use, due to concerns such as peripheral vasoconstriction, inducing vasospasm of the anastomoses, and leading to failure in perfusion. It has since become common practice in some centers to avoid intraoperative vasopressor use during free tissue transfer surgery. Recent studies have suggested that this traditional view may not be supported by clinical evidence. However, none of these studies have separated vasopressor use by method of administration.
Methods We conducted a retrospective review of our experience of vasopressor use in free flap surgery at a single high-volume center. The outcome measures were flap failure, flap-related complications and overall postoperative complications (reported using the Clavien–Dindo classification). Groups were compared using Chi-square or Fisher's Exact test where appropriate.
Results A total of 777 cases in 717 patients were identified. 59.1% of these had vasopressors administered intraoperatively. The overall failure rate was 2.2%, with 9.8% experienced flap-related complications. There was no difference in flap loss when vasopressors were administered, but an increased rate of microvascular thrombosis was noted (p = 0.003). Continuous administration of vasopressors was associated with reduced venous congestion, whereas intermittent boluses increased risk of microvascular thrombosis.
Conclusion Our study confirms previous findings that intraoperative vasopressor use in free flap surgery is not associated with increased failure rate. Administering vasopressors continuously may be safer than via repeated boluses.
This research present a system named Prioritization System (PS) to support the maintenance engineers while they are making the decision about the priorities for maintenance applications of school buildings. Distinguished from the other research done before, which built the priority model only with historical data, the PS presented in this research bases both on historical data and knowledge, which is deposited in a school maintenance knowledge base. The standard estimation criteria and electronic medicine documents of buildings are set into the PS, which will be integrated with a School Building Maintenance System (SBMS). Automatically prioritized by the system according to the estimation criteria could avoid mis-determining subjectively made by people themselves. Besides, the system enhances its decision support and reduces the replacement cost for management jobs.
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