Abstract

Introduction: Anesthetic management for free flap surgery contributes to flap survival, as hypotension is an independent predictor of flap loss. The optimal blood pressure range is unknown and there are no standardized guidelines available in this area. The aim of this integrative review was to provide evidence-based recommendations for hypotension management during microvascular free flap reconstruction surgery. Methods: Articles evaluating anesthetic related predictors of flap survival were critically appraised for validity, reliability, and rigor of study. Results: Current practice favors the use of fluids over vasopressors, supported by animal studies and anecdotal evidence. Clinical data demonstrated vasopressor use does not affect flap survival, and norepinephrine and dobutamine may improve flap outcomes. Both high and low fluid volumes affect flap complications (<3.5 mL/kg/hr; >6 mL/kg/hr). Over-resuscitation contributes to flap edema and under-resuscitation contributes to flap thrombosis. Excessively high fluid volumes are associated with increased rates of flap failure (>7 L total). Discussion: Hypotension management should aim for mean arterial pressures (MAP) > 65 mmHg. Vasopressors are recommended in the setting of normovolemia. Fluids should be titrated in a goal-directed manner via non-invasive monitors (urine output > 0.5-1.0 mL/kg/hr) and invasive monitors when possible (stroke volume variation < 13%). More research is needed to determine the exact type of fluid with minimal negative effects. Larger, prospective clinical trials are needed to strengthen findings of the existing evidence.

Lyndsie LaFleur

Author Details

Lyndsie LaFleur, DNAP, CRNA

Sigma Membership

Non-member

Type

Other Graduate Paper

Format Type

Text-based Document

Study Design/Type

Integrative Review

Research Approach

Other

Keywords:

Hypotension, Free Flap Reconstruction, Free Tissue Transfer, Vasoactive Drugs

Advisor

Pecka, Shannon

Degree

Doctoral-Other

Degree Grantor

Bryan College of Health Sciences

Degree Year

2020

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

Faculty Approved: Degree-based Submission

Acquisition

Proxy-submission

Full Text of Presentation

wf_yes

Download

Share

COinS