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Review
. 2023 Jul;43(5):496-506.
doi: 10.1002/micr.31047. Epub 2023 Apr 13.

Evidence based recommendations for perioperative vasopressor use and fluid resuscitation in microsurgery

Rachel Safeek  1 , Jaimie Bryan  2 , Frederick Heath  3 , Ellen Satteson  1 , Adrian Maurer  4 , Bauback Safa  5 , Sarah Sorice-Virk  1
Affiliations
Review

Evidence based recommendations for perioperative vasopressor use and fluid resuscitation in microsurgery

Rachel Safeek et al. Microsurgery. 2023 Jul.

Abstract

Blood pressure regulation is critical in patients undergoing microsurgical free tissue transfer; however, guidelines for addressing and preventing perioperative hypotension remain highly debated, with two current thought paradigms: (1) intravenous fluid administration with a balanced salt solution (e.g., lactate ringer and normal saline) and/or colloid (e.g., albumin) and (2) vasoactive pharmacological support with vasopressors (e.g., dobutamine, norepinephrine, epinephrine), with fluid administration being the preferred conventional approach. Here, we review the most up to date available literature and summarize currents perspectives and practices for fluid resuscitation and vasopressor use, while offering evidence-based guidelines to each.

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References

REFERENCES

    1. Al Saied, G., Almutairi, H. M., Alharbi, Y., Almohanna, M., & Almutairi, A. (2020). Comparison between the impact of vasopressors and goal-directed fluid therapy on the management of free flap reconstruction of head and neck and monitoring in ICU. Cureus, 12(12), e12108. https://doi.org/10.7759/cureus.12108
    1. Anker, A. M., Prantl, L., Strauss, C., Brébant, V., Heine, N., Lamby, P., Geis, S., Schenkhoff, F., Pawlik, M., & Klein, S. M. (2018). Vasopressor support vs. liberal fluid administration in deep inferior epigastric perforator (DIEP) free flap breast reconstruction: a randomized controlled trial. Clinical Hemorheology and Microcirculation, 69(1-2), 37-44. https://doi.org/10.3233/CH-189129
    1. Anker, A. M., Prantl, L., Strauss, C., Brébant, V., Schenkhoff, F., Pawlik, M., Vykoukal, J., & Klein, S. M. (2020). Assessment of DIEP flap perfusion with intraoperative indocyanine green fluorescence imaging in vasopressor-dominated hemodynamic support versus liberal fluid administration: A randomized controlled trial with breast cancer patients. Annals of Surgical Oncology, 27(2), 399-406. https://doi.org/10.1245/s10434-019-07758-1
    1. Banbury, J., Siemionow, M., Porvasnik, S., Petras, S., & Zins, J. E. (1999). Muscle flaps' triphasic microcirculatory response to sympathectomy and denervation. Plastic and Reconstructive Surgery, 104(3), 730-737. https://doi.org/10.1097/00006534-199909030-00018
    1. Brinkman, J. N., Derks, L. H., Klimek, M., & Mureau, M. A. M. (2013). Perioperative fluid management and use of vasoactive and antithrombotic agents in free flap surgery: A literature review and clinical recommendations. Journal of Reconstructive Microsurgery, 29(6), 357-366. https://doi.org/10.1055/s-0033-1343955

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