Goal-directed fluid therapy for microvascular free flap reconstruction following mastectomy: a pilot study

Funk, Duane J.; Bohn, James; Mutch, Wac; Hayakawa, Tom; Buchel, Edward W.

doi:10.1177/229255031502300405

Cited by 16 publications

(12 citation statements)

References 17 publications

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“…In total, 112 trials with 13 562 patients were included in this systematic review . The characteristics of the 112 included trials are listed in the supplements (Table A‐E).…”

Section: Resultsmentioning

confidence: 99%

Perioperative goal‐directed therapy: A systematic review without meta‐analysis

Kaufmann

Clement

Scheeren

et al. 2018

Acta Anaesthesiol Scand

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“…In total, 112 trials with 13 562 patients were included in this systematic review . The characteristics of the 112 included trials are listed in the supplements (Table A‐E).…”

Section: Resultsmentioning

confidence: 99%

Perioperative goal‐directed therapy: A systematic review without meta‐analysis

Kaufmann

Clement

Scheeren

et al. 2018

Acta Anaesthesiol Scand

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“…A prospective pilot study by Funk et al compared traditional parameters such as blood pressure and heart rate to noninvasive cardiac monitoring in patients undergoing mastectomy and microvascular reconstruction. 12 In comparison to the traditional parameters used to assess organ perfusion, goal-directed fluid therapy utilizing an elevated stroke volume variation (>13%) as a trigger for fluid boluses resulted in improved end operative hemodynamics. 12 The authors also noted that the use of a goal directed approach with Vigileo monitoring may have prompted earlier and more timely resuscitation, leading to improved end outcomes.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Tissue Oximetry-driven Fluid Resuscitation Improves Flap Perfusion in Autologous Free Tissue Breast Reconstruction

Karamanos

Ahmad

Hazboun

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Introduction: The use of tissue oximetry for monitoring following free tissue transfer has become a common practice to facilitate early detection of poor flap perfusion. We hypothesized that T stat readings may guide fluid administration in the postoperative period and improve perfusion in patients undergoing autologous breast reconstruction. Methods: Patients undergoing free flap breast reconstruction from 2015 to 2018 were reviewed. Mean percutaneous oximetry readings of the first four postoperative days were recorded. The mean change at 24 hours from the original reading was calculated (∆TO). The study population was divided in two groups based on whether administration of intravenous fluids (IVFs) was increased/maintained (group 1) or decreased (group 2) after postoperative day 1. Results: A total of 120 patients were identified. The mean age was 53, and mean BMI was 33. Overall, patients for whom fluid administration was decreased experienced an increase in their tissue perfusion, while patient who received a bolus or maintained the same rate of IVF experienced a decrease. Patients who had a negative ∆TO experienced a statistically significant difference between groups 1 and 2 at 24 and 72 hours (–4 versus +3 and –11 versus +13, respectively). For patients with a positive ∆TO, although decreasing fluids resulted in higher readings, it did not reach statistical significance at 24 or 72 hours (0 versus +2 and +4 versus +6, respectively). Conclusions: In patients undergoing free tissue breast reconstruction, tissue oximetry readings may be used as a novel guide for postoperative fluid management.

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“…Excessive fluid administration can lead to reduced blood flow in the flap secondary to development of interstitial edema and venous engorgement. [ 7 ] Goal-directed therapy may provide a better parameter for the optimization of fluid therapy in this population group.…”

Section: Discussionmentioning

confidence: 99%

Acute perioperative hyperlactatemia in oncoplastic reconstructive surgeries: What is the significance?

Roy

Bharti

Sinha

et al. 2021

J Anaesthesiol Clin Pharmacol

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Background and Aims: We aim to study the significance of intraoperative hyperlactatemia in reconstructive oncoplastic surgery. Material and Methods: A retrospective observational study was conducted on a cohort of patients who underwent reconstructive oncoplastic surgery with free flap for oral cancer over a 6-month period. The study population was divided into two groups based on peak lactate levels. Group N with peak lactate level less than 2 mmol/L and Group H peak lactate level more than 2 mmol/L. The various parameter studied were patient's comorbidities; intraoperative events (vasopressor requirement, blood transfusion, and duration of surgery); postoperative parameters including the need for re- exploration and duration of stay in hospital and intensive care unit. Results: The study demonstrates that intraoperative rise of lactate was not influenced by comorbidities. None of the intraoperative parameters studied influenced the lactate levels. Baseline lactate level was found to correlate with peak lactate level intraoperatively. But it was observed that there was normalization of lactate level within 24 hours postoperatively in both the groups. There was no difference in outcome parameters in the two groups. Conclusion: Intraoperative hyperlactatemia is not a significant prognostic factor for outcome in oncoplastic reconstructive surgery.

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Goal-directed fluid therapy for microvascular free flap reconstruction following mastectomy: a pilot study

Abstract: Goal-directed fluid therapy using minimally invasive cardiac output monitoring resulted in improved end-operative hemodynamics, with less 'rescue' fluid administration during the perioperative period.

Cited by 16 publications

References 17 publications

Perioperative goal‐directed therapy: A systematic review without meta‐analysis

Perioperative goal‐directed therapy: A systematic review without meta‐analysis

Perioperative Tissue Oximetry-driven Fluid Resuscitation Improves Flap Perfusion in Autologous Free Tissue Breast Reconstruction

Acute perioperative hyperlactatemia in oncoplastic reconstructive surgeries: What is the significance?

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