Anker, A. M. and Prantl, L. and Strauss, C. and Brebant, V and Heine, N. and Lamby, P. and Geis, S. and Schenkhoff, F. and Pawlik, M. and 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). pp. 37-44. ISSN 1386-0291, 1875-8622
Full text not available from this repository. (Request a copy)Abstract
BACKGROUND: Perioperatively, patients' hemodynamics are modulated predominantly by intravenous fluid administration and vasoactive pharmacological support. Vasopressor agents are suspected to be detrimental on free flap survival by the cause of vasoconstriction of the pedicle with consecutive reduced overall flap perfusion and by aggravation of flap dissection. OBJECTIVE: Anovel, standardized fluid restrictive perioperative hemodynamic managementwas assessed for its feasibility in clinical practice in free flap patients undergoing breast reconstruction. METHODS: Patients were randomized to two perioperative regimens with different fluid and vasopressor limits. The primary endpoint regarded flap survival. Secondary endpoints included surgery times, time of patient ambulation and length of hospital stay. RESULTS: There was one total flap failure with liberal fluid administration (LFA). No total or partial flap failure was noted in the fluid restrictive regimen with norepinephrine administration up to 0.04 mu g/kg/min (FRV). No delay regarding operation time (p = 0.217), patient mobilization (p = 0.550) or hospital discharge (p = 0.662) was registered in the FRV study subpopulation compared to LFA. CONCLUSIONS: The results of this prospective interventional trial could not detect any negative impact of vasopressors, neither for the primary endpoint of flap survival nor for the overall patient outcome. The fear of vasopressor associated flap complications has led to a traditional liberal fluid administration, which failed to demonstrate any benefits when compared to a fluid restrictive vasopressor strategy.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | FREE TISSUE TRANSFER; FAST-TRACK SURGERY; OF-THE-LITERATURE; ORTHOSTATIC INTOLERANCE; PERFUSION; NOREPINEPHRINE; MOBILIZATION; METAANALYSIS; EPINEPHRINE; ANESTHESIA; Deep inferior epigastric perforator (DIEP) flap; free flap; breast reconstruction; vasopressors; norepinephrine; liberal fluid administration |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Mund-, Kiefer- und Gesichtschirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 20 Mar 2020 13:52 |
| Last Modified: | 20 Mar 2020 13:52 |
| URI: | https://pred.uni-regensburg.de/id/eprint/15369 |
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