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- Title
Effect of goal-directed haemodynamic therapy in free flap reconstruction for head and neck cancer.
- Authors
Kim, H. J.; Kim, E. J.; Lee, H. J.; Min, J. Y.; Kim, T. W.; Choi, E. C.; Kim, W. S.; Koo, B.‐N.; Koo, B-N
- Abstract
<bold>Background: </bold>In free flap reconstruction for head and neck cancer, achieving a haemodynamic target using excessive fluid infusion is associated with decreased flap survival rates and extended hospital stays. We hypothesized that goal-directed haemodynamic therapy would improve flap survival rates and shorten hospitalization periods.<bold>Methods: </bold>Patients scheduled for free flap reconstruction were randomly assigned to a goal-directed haemodynamic therapy group (n = 31) or a conventional haemodynamic therapy control group (n = 31). The control group received extra bolus fluid and ephedrine or norepinephrine to maintain a mean arterial pressure ≥ 65 mmHg. The goal-directed haemodynamic therapy group received a colloid solution as the extra bolus fluid to maintain a stroke volume variation < 12%; dobutamine, ephedrine, or norepinephrine was administered to maintain a cardiac index ≥ 2.5 l/min/m2 and mean arterial pressure ≥ 65 mmHg. Enhanced recovery after surgery protocols were not used except for fluid therapy. An otolaryngologist blinded to group assignments assessed flap outcomes and classified them as 'survival,' 'at risk' or 'failure.'<bold>Results: </bold>The hospitalization period was not significantly different between the groups. The goal-directed haemodynamic therapy group had significantly shorter intensive care unit stays and a higher flap survival rate. The crystalloid volume was significantly lower in goal-directed haemodynamic therapy group. Reoperation rates, post-operative complications, and laboratory data including inflammatory markers were similar between the groups.<bold>Conclusion: </bold>Compared to conventional haemodynamic therapy, goal-directed haemodynamic therapy does not reduce hospitalization periods; it may, however, reduce the length of intensive care unit stays and increase flap survival rates. Further studies including multi-centre trials with larger sample sizes are warranted.
- Subjects
HEAD &; neck cancer; HEMODYNAMICS; DOBUTAMINE; HOSPITAL care; NORADRENALINE; STROKE; COMPARATIVE studies; SURGICAL flaps; FLUID therapy; HEAD tumors; LENGTH of stay in hospitals; INTENSIVE care units; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; NECK tumors; RESEARCH; EVALUATION research; RANDOMIZED controlled trials
- Publication
Acta Anaesthesiologica Scandinavica, 2018, Vol 62, Issue 7, p903
- ISSN
0001-5172
- Publication type
journal article
- DOI
10.1111/aas.13100