Intraoperative hypotension and flap loss in free tissue transfer surgery of the head and neck

Kass, Jason L.; Lakha, Sameer; Levin, Matthew A.; Joseph, Thomas; Lin, Hung‐Mo; Genden, Eric M.; Teng, Marita S.; Miles, Brett A.; DeMaría, Samuel

doi:10.1002/hed.25190

Cited by 28 publications

(35 citation statements)

References 25 publications

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“…Various predictors of complications have been proposed, such as ASA (American Society of Anesthesiologists) physical status, previous attempted microvascular transplants, surgery duration, and higher tumor stages, but their importance still remains controversial [ 1 , 5 , 6 , 9 , 10 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Perioperative predictors of early surgical revision and flap-related complications after microvascular free tissue transfer in head and neck reconstructions: a retrospective observational series

et al. 2021

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Objectives The aim of this study was to determine the influence of perioperative fluid management and administration of vasopressors on early surgical revision and flap-related complications in free tissue transfer. Materials and methods Intraoperative amount of fluid and of vasopressors, relevant perioperative parameters, and comorbidities were recorded in 131 patients undergoing head and neck microvascular reconstruction and compared with early surgical complications, defined as interventions requiring surgery after a flap-related complication, and/or other surgical problems in the operating room within 30 days after initial surgery. The relationship between perioperative variables for each revision category was determined using an optimized multiple logistic regression. Results The administration of diuretics (p=0.001) as a treatment for perioperative fluid overload and the type of flap (p=0.019) was associated with a higher risk of early surgical revisions. Perioperative fluid overload (p=0.039) is significantly related to flap-related complications. We found no effect of intraoperative administration of vasopressors on early surgical revisions (p=0.8) or on flap-related complications (norepinephrine p=0.6, dobutamine p=0.5). Conclusion Perioperative fluid overload is associated with higher risks of early surgical revision and flap-related complications. In contrast, the administration of vasopressors seemed to have no effect on either surgical revision rate or flap-related complications. Clinical relevance In patients receiving microvascular reconstructions, a balanced fluid administration perioperatively and a targeted use of vasopressors should be the necessary strategy to reduce the complication rates in head and neck surgery.

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Section: Introductionmentioning

confidence: 99%

Perioperative predictors of early surgical revision and flap-related complications after microvascular free tissue transfer in head and neck reconstructions: a retrospective observational series

et al. 2021

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“…As already mentioned, perfusion is the main issue Typically, the use of vasopressors to maintain adequate systemic blood pressure has been avoided [57].…”

Section: Hemodynamic Managementmentioning

confidence: 99%

“…Previously, based on the results of another study [62], the use of vasopressors such as norepinephrine had been avoided and the use of dobutamine had been favoured, which would generate an increase in systemic pressure by increasing cardiac output. In any case, it is convenient to remember that the use of vasopressors per se will not increase the survival of the flap [57], but rather that it will allow the solution of hypotension, the main risk factor for surgery failure; thus, its use should be individualized according to the clinical characteristics of each patient and administered cautiously.…”

Section: Hemodynamic Managementmentioning

confidence: 99%

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Anesthesia for Reconstructive Surgery of Head and Neck.

2020

jecor

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Reconstructive head and neck surgery is the main determinant of postoperative quality of life for patients who have undergone surgery for neoplastic pathology, since good aesthetic and functional results are essential to reduce the incidence of complications. To a large extent, the success of these results depends on a team of anesthesiologists who have advanced knowledge in airway management, preoperative risk assessment and hemodynamic implications of the different oncological surgery techniques. Even knowledge of anesthetic techniques (total intravenous vs. inhalational) seems to reduce complications related to pulmonary pro-inflammatory phenomena and improve flap viability. Reducing the incidence of infections, fistulas, nutritional management and tracheostomes is part of the active role of postoperative care units directed by anesthesiologists in conjunction with other specialties, which in part reduces hospital morbidity and mortality, improving the prognosis of our patients. In conclusion, multidisciplinary management in this type of patient is essential to guarantee better postoperative results.

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“…Spending an hour drying the surgical field after the ablative surgeon has left the theatre could lead to frustration and resentment within the surgical team. Anaesthetic factors have a direct influence on free flap success (11) and it is important to cultivate a good working relationship with the anaesthetist. Head and neck cases frequently run over normal operating session hours so there will need to be agreement about early starts or late finishes.…”

mentioning

confidence: 99%

Establishing a new head and neck microvascular reconstructive service

Barry¹

2021

Front Oral Maxillofac Med

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Intraoperative hypotension and flap loss in free tissue transfer surgery of the head and neck

Abstract: Intraoperative hypotension is associated to flap failure in head and neck free tissue transfer surgeries, as is large-volume fluid administration.

Cited by 28 publications

References 25 publications

Perioperative predictors of early surgical revision and flap-related complications after microvascular free tissue transfer in head and neck reconstructions: a retrospective observational series

Perioperative predictors of early surgical revision and flap-related complications after microvascular free tissue transfer in head and neck reconstructions: a retrospective observational series

Anesthesia for Reconstructive Surgery of Head and Neck.

Establishing a new head and neck microvascular reconstructive service

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