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Microsurgery vasopressor

Alejandro Cruz-Segura, Pedro Grajeda-López
Microsurgery is one of the most fertile and innovative area in reconstructive surgery. Today it is considered an indispensable technique in plastic surgery with flaps survival rates over 95% in main healthcare centers. The factors involved in achieving these results are: the improvement of the surgical technique, adequate patient selection and careful perioperative care. Perioperative care starts at the initial assessment of the patient where it's very important to consider the indications and contraindications of these procedures...
September 2017: Revista Médica del Instituto Mexicano del Seguro Social
John A LoGiudice, Karri Adamson, Nancy Ghanayem, Ronald K Woods, Michael E Mitchell
BACKGROUND: Pediatric congenital heart disease patients are at risk for vascular injuries during surgical procedures or when the arterial system is accessed for monitoring or diagnostic studies. Our treatment of emergent situations in this patient population using microvascular techniques shows the feasibility of such techniques. METHODS: A retrospective chart review of patients aged 0-18 years with congenital heart disease identified six patients who underwent microvascular surgery by the senior surgeon from June 2007 to May 2015...
May 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Saba Motakef, Paschalia M Mountziaris, Inzhili K Ismail, Richard L Agag, Ashit Patel
BACKGROUND: Free tissue transfer is an important technique in reconstructive surgery. Due to a lack of evidence-based guidelines, a variety of practices are currently implemented by microsurgeons. This motivated the authors to define current practices and identify key areas where these practices can be optimized. METHODS: An anonymous online survey consisting of 40 questions regarding perioperative management for free tissue transfer was generated via an online survey platform...
June 2015: Journal of Reconstructive Microsurgery
Krishna Vyas, Lesley Wong
OBJECTIVES: Intraoperative management of hemodynamic instability during microvascular flap reconstruction is often based on anecdotal experience. Randomized controlled trials are difficult to perform when overall success rates are high. This study seeks to determine current practices for management of intraoperative hypotension during microsurgical free tissue transfer. METHODS: An anonymous, 17-question, multiple choice, and open response online survey was distributed to university surgeons identified from the American Society of Plastic Surgeons and American Society of Reconstructive Microsurgeons online membership listing...
2014: Annals of Plastic Surgery
Ralf Brecht, Maximilian Friedrich, Paul Philipp Heinisch, Katharina Plonien, Bassil Akra, Christian Hagl, Ali Khoynezhad, Georg Lutter, René Bombien
OBJECTIVE: Transcatheter aortic valve implantation gained clinical relevance with an impressive and peerless power; however, the procedure induces unsolved complications such as paravalvular leakage, occlusion of coronary ostia, and vascular complications. The safe removal of bulky calcified valves will improve the outcome, well known through the open surgical procedure. In this article, a new stapler-based resection and implantation device as well as a new approach for valve isolation during normal heart cycle without extracorporeal circulation will be analyzed...
January 2013: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Pamela Hiltunen, Johanna Palve, Leena Setälä, Paula K Mustonen, Leena Berg, Esko Ruokonen, Ari Uusaro
Microvascular flap surgery is a common technique in reconstructive surgery. The wide indications and variable patients provide challenge also for anesthesiologist. Both hypotension and hypoperfusion can be harmful to the flap. Hypotensive patients are treated with fluid resuscitation and vasopressors (e.g., norepinephrine), if needed. As vasoconstrictors, vasopressors might impair microvascular flap perfusion. In this experimental pig model we studied the effect of sevoflurane-induced hypotension on the perfusion of microvascular and superiorly pedicled rectus abdominis myocutaneous flaps...
September 2011: Journal of Reconstructive Microsurgery
Chen Chen, Minh-Doan Nguyen, Eran Bar-Meir, Philip A Hess, Samuel Lin, Adam M Tobias, Joseph Upton, Bernard T Lee
The use of vasopressors during microsurgery is still debated. General anesthesia often induces hypotension, but microsurgeons are reluctant to use intraoperative vasopressors with the potential risks of vasoconstriction. A retrospective review was performed on 187 consecutive patients undergoing 258 deep inferior epigastric perforator flaps, free transverse rectus abdominis myocutaneous flap, and muscle-sparing free transverse rectus abdominis myocutaneous flap operations. A total of 102 patients (140 flaps) received intraoperative ephedrine and/or phenylephrine and 85 patients (118 flaps) did not...
July 2010: Annals of Plastic Surgery
Marcus M Monroe, Julie McClelland, Chris Swide, Mark K Wax
OBJECTIVE: To document the frequency of vasopressor use in free tissue transfer surgery and to compare the incidence of flap complications and flap survival in patients receiving or not receiving intraoperative vasopressors. STUDY DESIGN AND SETTING: Case series with chart review of free tissue transfers performed between 2004 and 2006 at a large-volume tertiary academic hospital. RESULTS: Of 241 free flaps, 169 had data available for analysis...
February 2010: Otolaryngology—Head and Neck Surgery
S J Jones, D A Scott, R Watson, W A Morrison
Free flap microvascular surgery involves the transfer of a mobilised tissue flap with complete vascular re-anastomosis at the new site. Ischaemia frequently threatens flap survival and may require a return to the operating theatre for anastomotic revision. Arterial spasm and hypoperfusion are recognised as factors in flap ischaemia. Phosphodiesterase inhibitors such as milrinone may improve flap blood flow and possibly flap survival by arterial dilation and increasing cardiac output. To investigate the role of milrinone in this type of surgery, a double-blinded randomised controlled trial was conducted with 88 patients receiving either a milrinone bolus and infusion throughout surgery or placebo (normal saline)...
October 2007: Anaesthesia and Intensive Care
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