Comparison Between the Impact of Vasopressors and Goal-Directed Fluid Therapy on the Management of Free Flap Reconstruction of Head and Neck and Monitoring in ICU

The Impact of Intraoperative Vasopressor Use and Fluid Status on Flap Survival in Traumatic Lower Extremity Reconstruction

“…It resonates with current perspectives in the literature that emphasize the importance of a careful balance between vasopressors and fluid administration to optimize flap outcomes. 20,21 Overall, intraoperative vasopressors tended to decrease the risk of postoperative flap necrosis; however, the results varied depending on net fluid balance. This study identified three distinct regions over the outlined net fluid balance when comparing the risk of flap necrosis based on vasopressor use, highlighting areas where its use may benefit.…”

“…careful balance between vasopressors and fluid administration in order to optimize flap outcomes. 20,21 Overall, intraoperative vasopressors tended to decrease the risk of postoperative flap necrosis; however, the results varied depending on net fluid balance. This study identified three This study's focus on LE flap reconstruction, particularly in the context of vasopressor use, offers a novel perspective compared with the more extensively researched area of head and neck reconstructions.…”

“…In contrast, drip or continuous infusion offers a more steady state but with the risk of prolonged exposure. 21 Studies have explored these dynamics, particularly their impact on microcirculation, but the literature remains divided. 17,23 The current study's focus on intraoperative vasopressor use without differentiation between bolus and drip administration leaves a gap that future research could fill, thereby contributing to a more nuanced understanding of the optimal vasopressor administration method in microvascular surgery.…”

Evidence based recommendations for perioperative vasopressor use and fluid resuscitation in microsurgery

“…A common component of ERAS protocols is goal directed fluid therapy (GDFT), in which stroke volume variation (SVV) >13% is targeted as the opportune timing for delivery of fluids to increase cardiac output. This may improve hemodynamics postoperatively while avoid fluid overload (Al Saied et al, 2020;Funk et al, 2015).…”

“…Evidence statement: Limit total fluid volume to <5.5 L on day of surgery. Over-aggressive fluid resuscitation poses significant risks for medical and surgical postoperative complications (Al Saied et al, 2020;Clark et al, 2007;Ettinger et al, 2017;Funk et al, 2015;Karamanos et al, 2020).…”