Anaesthetic challenging in microsurgical flap reconstruction: a systematic review
| Autor: | Prucher Gm, Caporali L, Lauretta Mp, Manera S, Melotti Rm |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Anaesthetic management
medicine.medical_specialty Reconstructive surgery Perioperative management business.industry Flap reconstructive surgery 030230 surgery Surgery 03 medical and health sciences 0302 clinical medicine Anesthesiology and Pain Medicine 030220 oncology & carcinogenesis Intraoperative management Anesthesia Inclusion and exclusion criteria medicine Head and neck surgery Major complication Prospective cohort study business |
| Popis: | Background: Anaesthetic management for microvascular reconstructive surgery is challenging and clearly affects the risk of major complications such as flap hypo-perfusion. In this systematic review we explore recent (last 7 years) clinical evidences related to perioperative management and anaesthetic controversy of patients undergoing microvascular reconstructive surgery, especially focused on head and neck surgery with free flaps (FF) and breast reconstructive surgery with deep inferior epigastric perforator flap (DIEP-flap). Methods: A literature search of published clinical studies between 2011 and 2018 was conducted, yielding a total of 4307 papers. Only 150 were eligible, according inclusion and exclusion criteria. Results: 62 studies were selected for this review and categorized in 3 groups: preoperative-intraoperativepostoperative anaesthetic management and areas of controversy for patients undergoing head and neck surgery with FF and breast reconstructive surgery with DIEP-flap. Discussion: Anaesthetic management for flap reconstructive surgery remains an open field of interest with limited evidences regarding a standard care. Main components of research currently are: the need to join standard multidisciplinary enhanced recovery pathways, as well as the necessity to develop a standard intraoperative management. In theatre, the recent hemodynamic parameter “Hypotension Probability Indicator” (HPI) is promising: the advantage to predict a drop in the mean arterial pressure can be more effective than a fluid therapy titrated to maintain SVV less than 13%. Prospective studies are necessary to clarify. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|