Anaesthesia for plastic and reconstructive surgery

Abstract

Plastic reconstructive surgeries involving flap reconstruction and microvascular anastomosis are technically demanding. Comorbidities such as diabetes, arterial insufficiency, anaemia and immunosuppression are common and increase the risk of ischaemia/reperfusion injury and vascular thrombosis. The anaesthetic goals are optimizing flap perfusion, improving flap survival and facilitating patients’ recovery. Intraoperatively, haemodynamic stability is maintained with goal-directed fluid therapy and judicious use of vasopressors. To minimize vasoconstriction, measures to maintain normothermia, adequate analgesia, sympatholytic regional anaesthesia and anti-emetic prophylaxis are employed. Prophylaxis for systemic venous thromboembolism and anastomotic thrombosis can be achieved with low-molecular-weight or unfractionated heparin and/or aspirin. Protocol-driven postoperative care with flap perfusion monitoring can reduce complications and facilitate recovery.