Anaes SAQs · Plastics and burns anaesthesia
Free flap reconstruction: perfusion-focused anaesthesia
Final-examination SAQ for free-flap-reconstruction.
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ANZCAFRCAEDAICABAFCAI
Prompt
Eight-hour lower limb free flap. Outline anaesthetic goals for flap survival and postoperative monitoring.
Model answer
Goals (5). Warm, filled, oxygenated, stable MAP near baseline with hypotension events defined as 5+ minutes below 65 mmHg, good analgesia — taught goal set within the perfusion-stability framing.[4][6]
Vasoactives (5). Volume first; if a pressor is needed after filling, individualise the agent with the surgeon noting the norepinephrine caution signal (review: failure 2% phenyl/ephedrine vs 6% norepi; DIEP/PAP series: any norepi dose linked to loss) — not a noradrenaline default.[4][5]
Post-op (5). Hourly flap obs with taught colour signs; urgent frictionless return to theatre if threatened (revision for compromise 12% overall).[4]
References6ShowHide
- [1]Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial). Lancet, 2008.PMID 18479744
- [2]Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation, 1999.PMID 10477528
- [3]Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2). Lancet, 2010.PMID 20554319
- [4]Ehmidat M, Khalil I, Abuzant R, et al. Pure Alpha Versus Mixed Adrenergic Vasopressors Perioperative Outcomes in Autologous Free Flap Surgery: A Systematic Review and Meta-Analysis. Plast Surg (Oakv), 2026.PMID 42039877
- [5]Larcher Q, Mernier T, Feigna M, et al. Impact of Norepinephrine Use on Free Flap Survival in Breast Reconstructive Microsurgery. Microsurgery, 2025.PMID 39865374
- [6]Philteos J, McCluskey SA, Emerson S, et al. Impact of goal-directed hemodynamic therapy on perioperative outcomes in head and neck free flap surgery: A before-and-after pilot study. Health Sci Rep, 2024.PMID 38524770