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首页> 外文期刊>The Open Anesthesia Journal >Effect of Dexmedetomidine on Postoperative Hemodynamics and Outcome of Free Flaps in Head and Neck Reconstructive Surgeries
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Effect of Dexmedetomidine on Postoperative Hemodynamics and Outcome of Free Flaps in Head and Neck Reconstructive Surgeries

机译：右美托咪定对头颈部重建手术术后血流动力学和游离皮瓣结果的影响

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Background and Aims: Dexmedetomidine is less frequently used during free flap surgeries for fear of causing vasoconstriction leading to flap failure as it is an α2 agonist. But most patients following major resections with free flap reconstruction develop uncontrolled hypertension postoperatively which could lead to complications resulting in reduced flap perfusion. We aimed to compare the effects of dexmedetomidine on postop haemodynamics, re-exploration rates and final outcome of free flaps in patients who underwent reconstructive surgeries.Material and Methods: This prospective, randomized study was conducted in 40 patients aged 20-70 years. Patients in both groups received morphine 0.1mg/kg, 30 minutes before end of surgery. In addition, in Group D dexmedetomidine 1mcg/kg bolus was also given at the same time, followed by 0.5mcg/kg/hr infusion. Post operatively the patients received either dexmedetomidine 0.5mcg/kg/h (Group D) or morphine 2mg/hr (Group M) infusion for 12 hours.Statistical analysis was done using Chi-Square test and independent sample t test.Results:Morphine group had significantly higher heart rate (105.2 ± 7.5 vs 90.0 ± 11.7), systolic blood pressure (167.5 ± 7.3 vs 125.4 ±16.6) and mean arterial pressures (103.5 ± 4.6 vs 87.8 ± 12.2) than dexmedetomidine group. Same trend persisted till 12 hours post operatively. More patients in morphine group required re-exploration of the flap (15 vs 10%) and had flap failure (7.5 vs 2.5%), but these differences were not statistically significant.Conclusion:Dexmedetomidine can be safely used in patients with free flap reconstruction as it optimizes postoperative hemodynamics and is not associated with any significant increase in re-exploration or flap failures.Key Messages:Dexmedetomidine resulted in optimal postoperative hemodynamics, reduced re-exploration rate and better flap outcome.
机译：背景与目的：右美托咪定是一种α2受体激动剂，在自由皮瓣手术中较少使用，因为它会引起血管收缩而导致皮瓣衰竭，因此担心。但是，大多数患者在进行大面积切除并进行游离皮瓣重建后，在术后发展为无法控制的高血压，这可能导致并发症，导致皮瓣灌注减少。我们的目的是比较右美托咪定对接受重建手术的患者术后血流动力学，再探查率和游离皮瓣最终结局的影响。材料与方法：这项前瞻性随机研究在40位20-70岁的患者中进行。两组患者在手术结束前30分钟接受吗啡0.1mg / kg。另外，在D组中，右美托咪定也同时推注1mcg / kg，然后输注0.5mcg / kg / hr。术后患者接受右美托咪定0.5mcg / kg / h（D组）或吗啡2mg / hr（M组）输注12小时，采用卡方检验和独立样本t检验进行统计分析。心率（105.2±7.5 vs 90.0±11.7），收缩压（167.5±7.3 vs 125.4±16.6）和平均动脉压（103.5±4.6 vs 87.8±12.2）明显更高右美托咪定组。相同的趋势一直持续到术后12小时。吗啡组中更多的患者需要再次探查皮瓣（15 vs 10％）并发生皮瓣衰竭（7.5 vs 2.5％），但差异无统计学意义。结论：右美托咪定可以安全使用游离皮瓣重建术可优化术后血流动力学，并且与再探查或皮瓣失败无任何显着增加有关。关键信息：右美托咪定可带来最佳的术后血流动力学，降低再探率并改善皮瓣结局。

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