Review Note
Last Update: 03/30/2025 10:15 PM
Current Deck: ACG Part 2::Plastic Surgery and Burns
New Card (Unpublished)Currently Published Content
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Commit #312101
SS_PB 1.1 Describe the physiological principles relevant to optimising blood flow to tissue flaps, including:
- What are the anaesthetic considerations to opitmise free flaps
- What are the anaesthetic considerations to opitmise free flaps
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Commit #312101- Maintain adequate MAP (~70-80 mmHg) to ensure sufficient driving pressure.
- Avoid hypothermia—warm OT, active warming to reduce SNS vasoconstriction.
- Optimise CO₂ levels—hypercapnia (PaCO₂ 40-45 mmHg) promotes vasodilation; hypocapnia reduces perfusion.
- Controlled fluid therapy—avoid excessive crystalloids, consider colloids and goal-directed therapy.
- Judicious use of vasopressors—low-dose ephedrine or dobutamine preferred over pure α-agonists (e.g., phenylephrine).
- Regional anaesthesia—reduces SNS tone, promoting vasodilation and better flap perfusion.
- Pain control—opioids, regional blocks, and multimodal analgesia to prevent SNS-induced vasoconstriction.