Clinical Update on Anaesthetic Management of Free Flap Surgery in Cervico Facial Cancer Patients

Cyrus Motamed,Lauriane Bordenave,Stéphanie Suria

doi:10.31487/j.acr.2020.01.03

Abstract

Intraoperative anaesthesia management in oro-facial cancer surgical patients requiring free flap tissue transfer is evolving. In this paper we updated our intraoperative clinical protocol using our own experience in combination with the latest literature. The main areas of change include videolaryngoscopic awake intubation in case of difficult airway management, combination of regional anaesthesia with peripheral catheter to decrease intraoperative opioid consumption, and postoperative pain and finally opioid free anaesthesia techniques using dexmedetomidine.

Highlights

Tumor excision of cervico-facial cancer followed by complex reconstructive microvascular surgery of free flap to replace defect or secondary reconstruction after removal of damaged tissues such as osteoradionecrosis are complex challenges in cervicofacial cancer patients
It is generally accepted that factors influencing final success of these procedures are mainly related to surgery and the patient itself such as vessel caliber, while anaesthesia related factors have a lesser impact [2]
Remifentanil TCI Opioid Free Anaesthesia (OFA): Dexmedetomidine (DEX) 0.3-0.5 μg/kg in 15 min followed by DEX 0.2 to 1 μkg/kg/h and a stepwise decrease every 2h in 0.2μg/kg/h and to be stopped 20 min before end of surgery

Summary

Introduction

Tumor excision of cervico-facial cancer followed by complex reconstructive microvascular surgery of free flap to replace defect or secondary reconstruction after removal of damaged tissues such as osteoradionecrosis are complex challenges in cervicofacial cancer patients. It is generally accepted that factors influencing final success of these procedures are mainly related to surgery and the patient itself such as vessel caliber, while anaesthesia related factors have a lesser impact [2]. Duration of anaesthesia which is related to duration of surgery has a negative impact [3]. This does not mean the anaesthetic technique has no effect at all since according to Hagen Poiseuille equation blood flow to the flap has a direct relation to systemic blood pressure [4]. V. Jejunum: Transverse Abdominal Plain (TAP) block, epidural anaesthesia is not performed because of low molecular weight heparin injection before graft vessels clamping.

Intraoperative Anaesthetic Management i Upon Arrival in the Operating Room

Discussion