Optimizing anesthetic support in plastic and reconstructive surgery

Abstract

Selecting the optimal method of anesthesia, depending on the operable area, concomitant pathologies, age, gender and last but not least, patient preferences. An important role plays the maintenance and / or improvement of vascular indices in the operated soft tissues, local temperature monitoring, as a parameter in the perioperative period of plastic reconstruction. Studies have been conducted, based on a sample of 74 patients aged 15-55 years in plastic - reconstructive surgery of the upper limb after trauma or bums. Operations have been performed: combined plastics (14), skin graft plastics (52), flaps plastics (4) and expander implantation (6). Depending on the methods of anesthesia, patients were classified into 4 groups: 1st group - 16 patients Loco-regional anesthesia (brachial plexus blockade-BPB); 2nd group - 22 patients Intravenous general anesthesia MR; 3rd group - 21 patients Intravenous general anesthesia RM with hypnotic of ultra short duration; 4th group - 15 patients Infiltrative anesthesia combined with intravenous anesthesia. No anesthetic complications were observed in any of patients. All pacients were undergoing hemodynamic monitoring of: BP, pulse, pulsoximetria, thermometry (central and peripheric), polarography. All indications listed were fixed in 4 - steps: I - preoperative II - stage of surgical anesthesia III - while performing surgery itself IV - end of the surgery In all 4 anesthetic groups were not observed manifest deviations of observed index levels: -BP -HBM -SpO 2 (peripheral blood oxygen saturation) But in some cases small deviations were observed: eg. in Group 3 by the anesthetic type - average BP in perioperative period decreased by 5.3%, resulting in increased heart rate - 15% HBM in the first stage, preoperative. Conclusions Monitoring of transcutaneous partial pressure of oxygen in operated areas as well as the central and the peripheral temperature gradient, and in the operated area, allow the correcting of the vascularisation of operated area in perioperative period. In case of locally anesthesia type, in plastic and reconstructive surgery, the oxygenation increase twice and the temperature increases with more than 14% in operated areas compared with other types of anesthesia. Increase indications and opportunities to loco-regional anesthesia in plastic and reconstructive surgeiy allow avoiding adverse effects and post anesthetic complications related general anesthesia and avoid the transfer of patients in intensive care recovery ward after the surgery.