Open AccessGoal-directed fluid therapy for microvascular free flap reconstruction following mastectomy: A pilot study
Author(s) -
Duane J. Funk,
James Bohn,
Wac Mutch,
Tom Hayakawa,
Edward W. Buchel
Publication year - 2015
Publication title -
plastic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.398
H-Index - 21
eISSN - 2292-5511
pISSN - 2292-5503
DOI - 10.4172/plastic-surgery.1000937
Subject(s) - medicine , anesthesia , stroke volume , central venous pressure , cardiac index , surgery , cardiac output , stroke (engine) , intravascular volume status , hemodynamics , blood pressure , mastectomy , pulse pressure , heart rate , breast cancer , cancer , mechanical engineering , engineering
Fluid management of the surgical patient has undergone a paradigm shift over the past decade. A change from 'wet' to 'dry' to a 'goal-directed' approach has been witnessed. The fluid management of patients undergoing free flap reconstruction is particularly challenging. This is typically a long operation with minimal surgical stimulation, and hypotension often ensues. The use of vasopressors in these cases is contraindicated to maintain adequate flow to the flap. Hypotension is often treated with intravenous fluid boluses. However, aggressive fluid administration to maintain adequate blood pressure can result in flap edema, venous engorgement and, ultimately, flap loss.